Responses to Ask a Spine Expert your SI Joint Question

Responses to Ask a Spine Expert your SI Joint Question

Q&A with Dr. Amish Patel – Available Below!

Amish R. Patel, DO, MPH
Interventional Pain Physician, Board Certified
Toledo, OH
Amish Patel Doctor Image

Dr. Amish Patel is a pain management specialist focusing on the spine. He is Board Certified in Physical Medicine and Rehabilitation. He is currently the Chief of Interventional Pain Management at Obleness Hospital, Bucyrus Community Hospital and Memorial Hospital in Ohio.

Dr. Patel has been diagnosing and treating patients with Sacroiliac Joint Issues for over 8 years. He uses the latest diagnostic techniques to accurately identify patients that have the SI joint as a pain generator.


May 2014

Jean:
I have pain in my right SI joint area and down my front upper right thigh. Is this a symptom of SI joint problems?

Dr. Patel:
Yes. It is in the differential. I would recommend an exam. If the provocative sacroiliac joint maneuvers increase your pain, start physical therapy with this being the diagnosis for 4 to 6 weeks. If you have completed 6 to 8 sessions with minimal benefit then I would recommend a therapeutic sacroiliac joint injection under fluoroscopic guidance 1 to 2 times. If you fail to get at least 6 months of satisfactory relief then I would recommend a diagnostic sacroiliac joint injection using only an anesthetic. If positive for at least an 80 percent reduction of your concordant symptoms with provocative activities then I would recommend a minimally invasive sacroiliac joint fusion using the IFUSE product.




Sameer:
After falling on my back while playing badminton, my MRI reveals:... Broad based left paracentral and foraminal disc bulge is seen at C7-D1 causing mild narrowing of left neural foramina... and ... Focal central disc protrusion are seen at C2-C3 to C4-C5 levels without any significant neural foraminal narrowing.

Dr. Patel:
Consult with a spine specialist. They will help corroborate which structural finding on your MRI is associated with clinical symptoms. Some of those findings on the MRI may be asymptomatic.




Gina:
I have always had a real bad back and I notice that my spine is way off, and by that I mean it's crooked. I really can't stand it anymore and I need know if it's has to do anything with my sacriloiliac?

Dr. Patel:
Yes. It is in the differential. I would recommend an exam. If the provocative sacroiliac joint maneuvers increase your pain, start physical therapy with this being the diagnosis for 4 to 6 weeks. If you have completed 6 to 8 sessions with minimal benefit then I would recommend a therapeutic sacroiliac joint injection under fluoroscopic guidance 1 to 2 times. If you fail to get at least 6 months of satisfactory relief then I would recommend a diagnostic sacroiliac joint injection using only an anesthetic. If positive for at least an 80 percent reduction of your concordant symptoms with provocative activities then I would recommend a minimally invasive sacroiliac joint fusion using the IFUSE product.




Beena:
It’s been 5 months since my husband had an L4/L5. Lately he started getting sudden and severe sneezing and running nose, putting him in a complete depressive state. Also, recently, he is not able to stand due to foot pain and we found thru Xray that he has Plantar fasciitis. Post-surgery, he is having issues with erection, too. The physical activity has completely gone down to zero comparatively. His back aches when we have intercourse. Are these the symptoms of FBS? Can you please explain the causes and what can be done.

Dr. Patel:
He could be developing sacroiliac joint pain syndrome from adjacent segmental stress from spinal fusion at L4/L5. Yes, it is in the differential. I would recommend an exam. If the provocative sacroiliac joint maneuvers increase your pain, start physical therapy with this being the diagnosis for 4 to 6 weeks. If you have completed 6 to 8 sessions with minimal benefit then I would recommend a therapeutic sacroiliac joint injection under fluoroscopic guidance 1 to 2 times. If you fail to get at least 6 months of satisfactory relief then I would recommend a diagnostic sacroiliac joint injection using only an anesthetic. If positive for at least an 80 percent reduction of your concordant symptoms with provocative activities then I would recommend a minimally invasive sacroiliac joint fusion using the IFUSE product.




M:
My back bone is very weak and I cannot bend. Can you help?

Dr. Patel:
Consult with a spine specialist that can educate you on which structural findings on your spine imaging studies is corroborative with your symptoms. However, strong core muscle is essential to staying upright.




Bianca:
I dread going to bed at night as I know I will wake up during the night with pain on one or both sides of my lower back - sort of at the back of the pelvis in the buttock. The pain shoots down into my leg/legs and I keep turning from left to right until I can't bear it and have to get up. Once I stand up the pain goes immediately. I have no pain whatsoever when walking and doing my daily activities. The problem occurs only once I have fallen asleep, I would say a few hours into my sleep it starts. I am a 64 year old female. If I take "Myprodol" which is a painkiller/anti-inflammatory capsule it helps but am loathe to libe on medication. My GP suggests I may have bursitis. Can you suggest any other possible cause? I would really appreciate your help and suggestions. Thank you most kindly.

Dr. Patel:
Sacroiliac joint pain syndrome is in the differential. I would recommend an exam. If the provocative sacroiliac joint maneuvers increase your pain, start physical therapy with this being the diagnosis for 4 to 6 weeks. If you have completed 6 to 8 sessions with minimal benefit then I would recommend a therapeutic sacroiliac joint injection under fluoroscopic guidance 1 to 2 times. If you fail to get at least 6 months of satisfactory relief then I would recommend a diagnostic sacroiliac joint injection using only an anesthetic. If positive for at least an 80 percent reduction of your concordant symptoms with provocative activities then I would recommend a minimally invasive sacroiliac joint fusion using the IFUSE product.




Ghada:
After a spondylolysis surgery, grade 2, when is it safe to make a transcontinental flight?

Dr. Patel:
Yes, you can travel. Follow your surgeon’s orders in terms of donning the back brace, avoiding certain movements, etc.




Venant:
The infuse implant is metal, correct? Will I have any issues traveling or going in the TSA screening machine? My pain is in my right backside in my hip - will I have to have my left side fused also? I was diagnosed with herniated discs in my lower back and in my neck. Could this have caused my sacroiliac flare-up? I also have Fibromyalgia which is the excuse for all doctors to do nothing but send me for therapy.

Dr. Patel:
Titanium. You may have issues with TSA screening. However your pain may be secondary to sacroiliac joint pain syndrome. I would recommend an exam. If the provocative sacroiliac joint maneuvers increase your pain, start physical therapy with this being the diagnosis for 4 to 6 weeks. If you have completed 6 to 8 sessions with minimal benefit then I would recommend a therapeutic sacroiliac joint injection under fluoroscopic guidance 1 to 2 times. If you fail to get at least 6 months of satisfactory relief then I would recommend a diagnostic sacroiliac joint injection using only an anesthetic. If positive for at least an 80 percent reduction of your concordant symptoms with provocative activities then I would recommend a minimally invasive sacroiliac joint fusion using the IFUSE product.




Ghada:
Need to know when can I drive after a spondylolysis surgery?

Dr. Patel:
Well, if you can sit and use your feet with precision utilizing the brake and foot pedals, then the odds of you being able to drive post-surgery is much higher.




Ghada:
Quick background: Both of my SI joints are hypermobile. The right side is what one Doctor described as “my” normal due to the amount that my left joint moves. My left SI joint was described as being "messy" and moves much more than the right side. There is no question as to whether or not my chronic pain is due to an SI joint problem; I have had 4 separate, well-educated doctors and professionals all agree: my left SI joint is too mobile. My question is: Will using an SI joint belt help alleviate the pain? I currently take medicstion, exercise (healthy lifestyle) and have tried SI joint injections with a success rate of 30 - 40 %.

Dr. Patel:
It could work. I would try it for a few weeks. If your symptoms fail to progress, then I recommend a minimally invasive sacroiliac fusion using the IFUSE product.




Ibrahim:
Two years ago I had kidney stone removal by shock wave. Since then, nothing has changed: I'm still feeling the same pain in my lower back right side, my back, neck, chest, belly, and I can't walk without feeling severe pain in my back and lower sides.

Dr. Patel:
It is possible the back symptoms could be emanating from the sacroiliac joint. I would recommend an exam. If the provocative sacroiliac joint maneuvers increase your pain, start physical therapy with this being the diagnosis for 4 to 6 weeks. If you have completed 6 to 8 sessions with minimal benefit then I would recommend a therapeutic sacroiliac joint injection under fluoroscopic guidance 1 to 2 times. If you fail to get at least 6 months of satisfactory relief then I would recommend a diagnostic sacroiliac joint injection using only an anesthetic. If positive for at least an 80 percent reduction of your concordant symptoms with provocative activities then I would recommend a minimally invasive sacroiliac joint fusion using the IFUSE product.




Alden:
I have a bone quality grade of -3.5. Would that eliminate me as a patient for iFuse surgery?

Dr. Patel:
No, but it may delay the bone healing process.




Edward:
I have a chronic sweating neck pain. I have tried many hospitals and painkillers. No change. The pain has extended to all joints and my back. In fact, there seems to be a band of pains all around my body, including my chest. How do I get out of this bondage? At night it appears as if all my bolts and nuts are loosed. I have also been living with a peptic ulcer which has been extensively treated.

Dr. Patel:
Your low back symptoms could be emanating from the sacroiliac joint. I would recommend an exam. If the provocative sacroiliac joint maneuvers increase your pain, start physical therapy with this being the diagnosis for 4 to 6 weeks. If you have completed 6 to 8 sessions with minimal benefit then I would recommend a therapeutic sacroiliac joint injection under fluoroscopic guidance 1 to 2 times. If you fail to get at least 6 months of satisfactory relief then I would recommend a diagnostic sacroiliac joint injection using only an anesthetic. If positive for at least an 80 percent reduction of your concordant symptoms with provocative activities then I would recommend a minimally invasive sacroiliac joint fusion using the IFUSE product.




Jose:
I just had an MRI on my upper and lower lumbar. The results:

Back IMPRESSION: Epidural lipomatosis gradually increases from L3/4 through L5-S1 causing progressive compression of the thecal sac which is mild to moderate at L3-4 and severe at L4-5 and L5-S1. The osseous spinal canal is also narrowed but considered mild-to-moderate at these levels.

Neck IMPRESSION: Severe narrowing of the left C6-7 neural foramen. Mild degenerative changes as described in detail above.

My pain management specialist hasn't given me his suggestions. I would like a second opinion from you. I have been in pain for the last 25 years, and for the last 6 months I can hardly walk uphill now and the pain is almost unbearable. What can you recommend for the pain?

Dr. Patel:
Your back pain could be emanating from the sacroiliac joint. I would recommend an exam. If the provocative sacroiliac joint maneuvers increase your pain, start physical therapy with this being the diagnosis for 4 to 6 weeks. If you have completed 6 to 8 sessions with minimal benefit then I would recommend a therapeutic sacroiliac joint injection under fluoroscopic guidance 1 to 2 times. If you fail to get at least 6 months of satisfactory relief then I would recommend a diagnostic sacroiliac joint injection using only an anesthetic. If positive for at least an 80 percent reduction of your concordant symptoms with provocative activities then I would recommend a minimally invasive sacroiliac joint fusion using the IFUSE product.




Michael:
I am a 43 year old male, who is fit and exercises on a daily basis. For the past 3 months I have been suffering from lower back stiffness, sciatic nerve pain and am unable to walk more than a mere 300 metres. Cycling and swimming have not been affected so thank God I manage to keep fit . After many treatments such as acupuncture, chiro, deep tissue massages were unsuccessful I took an MRI scan yesterday: Disk protrusion at L4-L5 causing spinal canal narrowing and impingement on the transiting L5 nerve roots bilaterally. I will be seeing my doctor next week but would highly appreciate any kind of help for these findings.

Dr. Patel:
If you are having pain along the posterior lateral buttock, lateral thigh and lateral calf worse with walking, then the L5 nerve root is the cause of the lower limb pain. I would recommend a bilateral L5 transforaminal epidural 1 to 2 times in conjunction with a flexion biased stabilization program. If your symptoms fail to progress, then get the surgery for the leg pain




Coleen:
I had an RF done on C-2 through C-5 three months ago. I have since had increased and severe pain, headaches, numbness, sensitivity,etc. and nothing seems to be getting any better, even after several attempts of additional injections, medial branch blocks, etc. Is there anything that you could offer as advice? I just would like to get better.

Dr. Patel:
It is uncommon to have neuropathic pain 3 months after an. Those symptoms should continue to improve. If not, then it is possible the ventral root was heated causing this pain. I would recommend an electrodiagnostic evaluation to see if a cervical radiculopathy is taking place.




Vivek:
I am a 30 year old male. For the last 7 years I have been suffering from a pain that starts from right hip/lower back and goes into thighs. The pain is radiating and comes on and off. After several tests including MRI, Uric acid etc. the doctors have inferred that it is due to SI joint inflammation. Adding salt to wounds, I have been diagnosed with HLA-b27. I don't have other complications associated with AS (its been 7-8 years) since this pain first occurred. Once the pain comes I start taking the pills until it subsides, and this story repeats at least once every quarter.

My Questions are:

Q1) What are your views on my problem? Do you think it is only SI joint problem or I have AS as well?

Q2) What are the prognoses of this problem?

Q3) How can I get permanent solution for this problem?

Q4) Does working out in a gym aggravate this problem?

Dr. Patel:
Yes, it is in the differential. I would recommend an exam. If the provocative sacroiliac joint maneuvers increase your pain, start physical therapy with this being the diagnosis for 4 to 6 weeks. If you have completed 6 to 8 sessions with minimal benefit then I would recommend a therapeutic sacroiliac joint injection under fluoroscopic guidance 1 to 2 times. If you fail to get at least 6 months of satisfactory relief then I would recommend a diagnostic sacroiliac joint injection using only an anesthetic. If positive for at least an 80 percent reduction of your concordant symptoms with provocative activities then I would recommend a minimally invasive sacroiliac joint fusion using the IFUSE product.

From a rehab standpoint, strong gluteal and hamstring muscles are very important along with hamstring flexibility in the supine position only.




Kate:
I am a 34 year old single mother with five children. I have had many issues with my L4/5 since the age of 9, due to landing incorrectly in a jump from a two story building (L4/5 took the brunt). Due to yet another debilitating sciatic nerve pain running through to my right ankle, I had a new CT scan today which says the following: there is evidence of disc degeneration with moderate to marked disc space narrowing, lipping of the vertebral margins, gas densities in the disc space and slight diffuse bulging of the annulus. Minor apophyseal joint degenerative changes. Should I now be requesting an MRI, and is surgery now inevitable? If so, what kind of op would best benefit me for the long term?

Dr. Patel:
An operation for low back pain is not the best option long term. Improving pelvic flexibility, especially the hamstrings, is of most importance in the supine position. Remember: the MRI will continue to show interval changes but it fails to correlate your subjective symptoms. You will need to get an opinion from a spine specialist to help delineate which findings are causing your symptoms.




Lee:
I sprained my lower back during deadlifts and my Chiro has indicated this is no more than a simple sprain. While my back is improving every day (it’s been about 10 days), I have a persistent sensation in my calf which I liken to a mild version of when you fall asleep on your arm and it is limp/un-coordinated. Is this a usual part of the healing and likely where the inflammation of the ligament may be affecting a nerve - or could this be a pointer to disc damage?

Dr. Patel:
The S1 nerve root could be irritated from a herniated disc. I would recommend an MRI of the lumbar spine. If it shows a herniated disc at L5-S1 then I would recommend an S1 transforaminal epidural injection if you are having pain down the back of the leg. If not, get lumbar traction and improve your hamstring flexibility in a supine position.




Debbie:
I have had TLIF on my L4-l5 region. I had nerve pain from my back to my foot. After the surgery I still have the nerve pain and developed severe pain in my SI joints and severe pain with a severe burning sensation in my hip joints. My left leg burns as well as my foot. When I walk more than 10 minutes my leg gives out and unable to stand or walk any longer. I cannot stand to ride in a car, walk, stand, or sit and I am barely able to do stairs. I have just been told by a neurologist that nothing is wrong with me and I just need to walk and strengthen. Can you please offer some insight?

Dr. Patel:
Yes, it is in the differential. I would recommend an exam. If the provocative sacroiliac joint maneuvers increase your pain, start physical therapy with this being the diagnosis for 4 to 6 weeks. If you have completed 6 to 8 sessions with minimal benefit then I would recommend a therapeutic sacroiliac joint injection under fluoroscopic guidance 1 to 2 times. If you fail to get at least 6 months of satisfactory relief then I would recommend a diagnostic sacroiliac joint injection using only an anesthetic. If positive for at least an 80 percent reduction of your concordant symptoms with provocative activities then I would recommend a minimally invasive sacroiliac joint fusion using the IFUSE product.




Annabelle:
When it is cold, I have pain in my right arm. I am not fond on taking pain relievers so I just massage it with massage oil or put a hot compress on, but still the pain is there. What should I do?

Dr. Patel:
Differential is cervical radiculopathy, peripheral nerve injury or reflex sympathetic dystrophy to name a few. Consult with a pain specialist to refine and establish a probable diagnosis for your symptoms.




Sharmi:
I have been suffering from sacralization for the last 8 years. Now the low back pain and numbness in my leg is getting worse and I am under treatment with gabapentin. Can I opt for a decompression surgery?

Dr. Patel:
I would recommend an exam. If the provocative sacroiliac joint maneuvers increase your pain, start physical therapy with this being the diagnosis for 4 to 6 weeks. If you have completed 6 to 8 sessions with minimal benefit then I would recommend a therapeutic sacroiliac joint injection under fluoroscopic guidance 1 to 2 times. If you fail to get at least 6 months of satisfactory relief then I would recommend a diagnostic sacroiliac joint injection using only an anesthetic. If positive for at least an 80 percent reduction of your concordant symptoms with provocative activities then I would recommend a minimally invasive sacroiliac joint fusion using the IFUSE product.

If the exam and injection fails to establish a diagnosis of sacroiliac joint pain syndrome, I would consult with a spine surgeon on whether decompression is the best option. This is typically reserved if your symptoms are secondary to a lumbar radiculopathy.


April 2014

Margarida:
I have been suffering from back pain since October 2013. The pain goes down my right leg to the foot. My leg feels numb quite often. I’ve been on medication for a long time and it is not working. What do you think may be wrong?

Dr. Patel:
It seems this could be a lumbar radiculopathy from a herniated disc or spinal stenosis or sacroilitis. I would recommend an MRI of the lumbar spine without contrast if you have had no prior lumbar spinal surgeries. If positive for structural evidence to substantiate a lumbar radiculopathy, then get a lumbar transforaminal epidural steroid injection 1-2 times. If you fail to get any significant relief for at least 12 weeks then proceed with surgery. However if the MRI of the lumbar spine is equivocal for a lumbar radiculopathy then get a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive for significant pain relief with functional activities for the half-life of the anesthetic then I would recommend a therapeutic sacroiliac joint injection in conjunction with a pelvic stabilization program. If you fail to progress, then consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Jeannine:
I had back surgery 7 years ago and now I have pain on my left side (down by L5) going into my groin and down my leg; sometimes it goes into my hip. Could this be the SI joint? I also had a fall almost a year ago and this has been coming on ever since. It was real bad at first, mostly in the low back, but now its real bad on the left side and in the groin and down my leg.

Dr. Patel:
If these symptoms occurred as a result of the fall then it is quite possible the sacroiliac joint is the source of the pain. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive for significant pain relief with functional activities for the half-life of the anesthetic then I would recommend a therapeutic sacroiliac joint injection in conjunction with a pelvic stabilization program. If you fail to progress, then consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Varghese:
Per my recent MRI report there is L5-S1 nerve compression causing severe pain to radiate to left fingers through ankle and muscles. Surgery is an option as per a Neurosurgeon in Bangalore, India, but per another doctor surgery may be avoided. I am confused. My main worry/question is whether the surgery can cause damage to nerves and are there chances for paralysis?

Dr. Patel:
I would recommend a lumbar transforaminal epidural steroid injection around the L5 and/or S1 nerve root. If that does not help with the pain I would recommend the surgery. Paralysis is always a risk but is a low one. The risk of paralysis is higher if it is for spinal stenosis and lower for a herniated disc.




Ali:
My right thigh, just above my knee, has been painful for the past few days and is more painful when I am sitting. I have tried pain killers and pain reliever sprays and ointment. Any suggestions? Many say it’s because of driving.

Dr. Patel:
Your symptoms may be secondary to sacroiliac joint pain syndrome. I would recommend diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive for significant pain relief with functional activities for the half-life of the anesthetic then I would recommend a therapeutic sacroiliac joint injection in conjunction with a pelvic stabilization program. If you fail to progress, then consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Tamica:
I would just like a second opinion on my MRI results. It says:
1. Cervicomedullary junction correctly positioned and cervical cord signal normal.
2. Minimal degree of central disc bulging at c3/4. No significant central or foraminal narrowing.
3. Minimal degree of central disc bulging at c4/5. No significant central or foraminal narrowing.
4. At c5/6, a small subligamentous annular tear in the disc and a small disc bulge barely touching the cord. No significant foraminal narrowing.
CONCLUSION: Small disc bulge associated with an annular tear at c5/6 minimally touching the cord.

My Doctor says there's nothing I can do except be careful (take pain killers when needed, etc). I'm a 30 year old female and trying to conceive at the moment. I have days where I cannot move my neck for about 4 days (pain and length varies), but usually very painful to the point I had my partner take me to the hospital. I also get this in my lower back; it seizes up and I can't move for a couple of days (no MRI done on lower back). I have had x-rays and from muscle spasms in my neck they have pulled my spine (my C shape in neck) out to nearly straight. Also, I have a slight curve to the right in my spine (about 3 quarters down my back) and my tail bone is twisted (not sure how badly). So with all this I'm worried of course, especially the bit where it says “minimally touching cord” (I'm guessing this means spinal cord)! Could you please explain a little more about what all this means as I really have no idea. Will getting pregnant aggravate all of this?

Dr. Patel:
If have strictly neck pain it could be related to a disc bulge. However one of the complexities in musculoskeletal medicine is correlating a particular set of symptoms with a structural problem. You will need to see a spine specialist to help correlate the two.




Rohini:
I am 30 yrs old and I am suffering from L5 S1... Doc said it’s a disc bulge and I need to be careful. How this can be cured as we are planning for a baby?

Dr. Patel:
The only way to cure degenerative disc disease is potentially through intradiscal stem cell treatments. However avoiding bending forward and improving hamstring flexibility in the supine position and lumbar traction are the best remedies for disc related pain along the lumbar spine.




Clement:
I feel a warm sensation on my legs, more pronounced on the left and also on the left hand. I have issues with my spine.

Dr. Patel:
Okay. Go see a spine specialist and get an evaluation. It could be a pinched nerve in the low back or additional issues from the pelvis.




Mahlon:
I've had Sciatica for 5 yrs. I've gotten epidural shots that really helped great for 4 years but this past September the pain returned. I've had 2 epidural shots and the sciatic pain has decreased, but it seems the area in front of my pelvis is always sore. The more I walk, the more painful it becomes. This is the first time I've seen information about Sacroilliac Joint Inflammation. When I cross my right leg over my left knee it is very painful. What are your thoughts on this situation?

Dr. Patel:
I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive for significant pain relief with functional activities for the half-life of the anesthetic then I would recommend a therapeutic sacroiliac joint injection in conjunction with a pelvic stabilization program. If you fail to progress, then consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Beatriz:
I am not suffering from pain. I am a 65 year old female, healthy in general, and I take calcium and omega 3 for my bones. About 5 years ago my back left shoulder started making a cracking sound when I move to stretch or exercise (e.g., raising my arms or rotating). I know this is part of getting old, but can I help my body by taking some natural medicine? I would like to understand where these sounds of cracking or popping area coming from when I move, especially my left side. It sometimes causes me pain.

Dr. Patel:
The cracking and popping is called crepitus which is a manifestation of the arthritic process where structures simply come in direct contact with one another or the joint space has deteriorated creating turbulence with shoulder movement.




Elizabeth:
Could having arthritis in my right SI joint cause me to have a ruptured disk on the left side of my spine ? I received a steroid injection in my right hip and my pain went away, but two months later I was working and unloading several cases of water and other heavy stuff to the point that I knew something bad had happened (I wanted to think I had just pulled a muscle because I have had pain before from my SI joint and I knew this wasn't the same pain or feeling at all, plus it was my left side that was hurting). I had an MRI and it showed a fresh injury to my S1/ L5 disc so I had to have two surgeries to remove my S1 disc !!! The problem I'm having is that Workmens Comp is trying to say that my right SI joint could have caused me to rupture my disc on my left side and I had fluid leaking into my spine and that I could've worked for 6 weeks with a ruptured disc !!! My surgeon has told me that there is no connection between me having a ruptured disk and right SI joint arthritis.

Dr. Patel:
If you want to help your case, try to get a C9 approval for a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive for significant pain relief with functional activities for the half-life of the anesthetic then I would recommend a therapeutic sacroiliac joint injection in conjunction with a pelvic stabilization program. If you fail to progress, then consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




David:
I have been working with a pain specialist for a while. We have narrowed my lower back pain down to the SI Joint. I obtain immediate relief when the numbing agent is injected as part of his standard steroid injection process. I have had two shots so far with only temporary relief. I am preparing for a third shot, and would like to be as prepared as possible for the next step.

Dr. Patel:
If the diagnostic sacroiliac joint injection under fluoroscopic guidance is positive for significant pain relief with functional activities for the half-life of the anesthetic and the therapeutic sacroiliac joint injection in conjunction with a pelvic stabilization program failed to relieve your symptoms, then the next step is to consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Diane:
I have suffered low back pain for the last 31/2 years with no relief. I have been back & forth to physio which hasn't helped. I have a lot of pain in the bony part of my buttocks, sciatica and sometimes wake up with pain in my hips. I also wake up at times with a painful ribcage. My physio says she can't do any more for me and sent me back to my doctor. I take Gabapentin, cocos amok (could this be “glucosamine?”) and naproxen. In the last few months I have had swelling over the sacroiliac joint area and asked to be referred to a rheumatologist. My doctor insists I have nerve damage but sent me for an x-ray anyway; however, my x-ray was normal & there is a 12 month waiting list for the rheumatologist. I am due to have acupuncture next month for this "nerve pain". Is there anything else I should ask my doctor to do? I am 44years old and this has had a colossal impact on my life.

Dr. Patel:
It could be a sacroiliac joint dysfunction. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive for significant pain relief with functional activities for the half-life of the anesthetic then I would recommend a therapeutic sacroiliac joint injection in conjunction with a pelvic stabilization program. If you fail to progress, then consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Neha:
Have you heard about intraosseous blockade? What do you think about this treatment? I read about this information on a website.

Dr. Patel:
I would recommend a lumbar transforaminal epidural injection than an intraosseous blockade for lumbar radiculitis. The evidence supports that lumbar transforaminal epidural injection is effective. I would consider intraosseous blocks investigational.




Sharlotte:
Regarding the I Fuse system: are you a candidate if you are fused already? A horseback injury and multiple surgeries to my spine ended up with Osteomyelitis which caused natural fusion of L5S1. I still suffer badly from low back pain into my legs and hips. I want to know if this type of surgery is an option. I also suffered a CSF tear during one surgery from which I ended up one week later in emergency surgery to repair.

Dr. Patel:
If you are fused at L5-S1 then yes, IFUSE maybe an option if sacroiliac joint dysfunction is the cause of pain. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive for significant pain relief with functional activities for the half-life of the anesthetic then I would recommend a therapeutic sacroiliac joint injection in conjunction with a pelvic stabilization program. If you fail to progress, then consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Jen:
I was born with right hip dysplaysia which was not treated. I have walked with a right limp my whole life. I am 40 years old now. Two years ago I woke up one morning unable to turn over or sit up. It took months to find out the cause: right SI joint problem. I walked with an outswing step with my right leg for about 6 months until I got a cortisone shot in my hip (right bursa), then I was able to walk better. At that time it was discovered that I have very little muscle mass in my right buttocks or lower leg due to my birth defect/dysplaysia. I have an overly large muscle group in my right thigh in the front that is compensating for the lack of other muscles. I have been toughing it out, but this year I have been struggling to walk up and down stairs, and I cannot step all the way forward with my right leg. Went back to my orthopedist, and she is sending me to a hip specialist surgeon to hopefully get my hip repaired or replaced. BUT... 3 weeks ago I had the same issue with the Left SI joint where I could barely sit up or turn over. (Not as bad as the first time where I was totally crippled). I just had x-rays done and they are showing a significant misalignment of my pelvis. My question is... will getting my hip repaired cure the SI joint problem, or will I need a separate treatment for the SI joint?

Dr. Patel:
If the problem is from the sacroiliac joint then yes there are treatments than help cure these symptoms. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive for significant pain relief with functional activities for the half-life of the anesthetic then I would recommend a therapeutic sacroiliac joint injection in conjunction with a pelvic stabilization program. If you fail to progress, then consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Carol:
I hurt my back about 6 years ago while twisting to shut my van’s back door. I am a CNA and have worked in the medical field for 35+ years. After the incident I was in the most tremendous pain of my life! I could not walk, dress, shower, or do anything for myself. I finally saw a doctor who did an MRI which showed bulging discs at L4&L5 & S1. I had horrific pain across my pelvis, in my right L. quadrant, and in my lower back. I wake up every night with severe pain in my groin area and around my pelvis, unable to sleep or move. When I do a little cooking, I suffer badly the next day. I can no longer enjoy the simple things in life. I am in the process of divorce and must pack and move many boxes by myself. I also have a torn rotator cuff in my right arm and I find it almost impossible to pack up my personal things and then have to put them away. I suffer greatly after doing the simple standard daily living things we all must do. The doctor says I need a fusion. Can you suggest anything else I could do to ease my pain and do my daily living activities without them doing me in for a day or so? I am very depressed and have little to no help. I would love to hear about this IFuse in my area. I cannot go on living with this severe pain!

Dr. Patel:
The IFUSE product is a useful one for signs and symptoms of sacroiliac joint pain syndrome. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive for significant pain relief with functional activities for the half-life of the anesthetic then I would recommend a therapeutic sacroiliac joint injection in conjunction with a pelvic stabilization program. If you fail to progress, then consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Ramona:
I had surgery on my neck and my right side is numb - I don't feel it. I am having too much pain on my neck and back and it takes my whole right side. I can hardly walk. I am going to physical therapy and taking my meds on time. I had my first surgery done last spring and the 2nd surgery in the Fall. I am having lots of pain.

Dr. Patel:
I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive for significant pain relief with functional activities for the half-life of the anesthetic then I would recommend a therapeutic sacroiliac joint injection in conjunction with a pelvic stabilization program. If you fail to progress, then consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Aleida:
I would like to know if there is any cure for sacroiliac joint and lumbar and what it is the meaning.

Dr. Patel:
There are treatments options that could help to cure signs and symptoms of sacroilitis. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive for significant pain relief with functional activities for the half-life of the anesthetic then I would recommend a therapeutic sacroiliac joint injection in conjunction with a pelvic stabilization program. If you fail to progress, then consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Margaret:
I have had back pain since age 18 when I was treated for lumbago sciatica. Recently I have been diagnosed with one leg being longer than the other by 14cm. I am using a raised insole but the pain in my low back is still very bad. I have also been diagnosed with degenerative spine and osteoarthritis of the spine: "broad based posterior and foraminal disc bulge is seen at l4/5 level and along with ligamentum flavum hypertrophy/bucking is causing thecal sac indentation and compression on bilateral existing nerve roots producing a canal diameter of approx 1.5cm.”

Dr. Patel:
The leg length discrepancy could create a dysfunction along the sacroiliac joint. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive for significant pain relief with functional activities for the half-life of the anesthetic then I would recommend a therapeutic sacroiliac joint injection in conjunction with a pelvic stabilization program. If you fail to progress, then consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Arsian:
Please tell me the best treatment for this diagnosis: “Broad based posterior and foraminal disc bulge with left para-central disk protrusion causing attention of left neural foramen is seen at l5/s1 level and along with ligamentum flavum hypertrophy/buckling is causing thecal indentation and compression on bilateral exiting nerve root producing a canal diameter of approx 0.8cm.”

Dr. Patel:
If you are having radicular pain down the left lower extremity in the L5 and/or S1 distribution I would recommend a lumbar transforaminal epidural steroid injection under fluorscopic guidance 1-2 times. If it fails to relieve your symptoms for at least 3 to 6 months then I would recommend the surgical alternative.


March 2014

Martins:
Can low back pain cause paralysis of the legs?

Dr. Patel:
Yes. Lumbar spinal stenosis and lumbar disc herniation can cause a condition called radiculopathy. This condition can lead to paralysis and or weakness of the legs.




Kuldeep:
I have had pain in my right SI joint for 8 months. It is very painful, and it makes it impossible to run or play any sports (I am 21). It is also very painful when I try to turn in bed. I have been taking NSAIDS for 2 months, to no avail.

Recently something weird has happened. The pain has stopped on the right side, and now happens on the left side, except with a much greater intensity. The pain is very sharp.

Dr. Patel:
These things can happen. The only thing I can think of is that you may have compensated favoring the unaffected side when your pain on the right side was great. Your symptoms can still be managed and possibly cured. If the pain is related to the sacroiliac joint, options that are available would include, but are not limited to, manipulation, therapeutic injections and minimally invasive sacroiliac joint fusion.




Mary:
I've done damage to my neck at C5 and C6. I’m sick of going to the hospital where they won't do anything for me and only send me home with pain killers. I’m only 30 years old and don't want to be taking pain killers. Now I’m getting a lot of pain down my neck to my lower back, then to my legs and into my toes which I can't bear anymore. Can you help me please on what I can do?

Dr. Patel:
Have you had surgery for this condition? If you have significant pain shooting down the upper limbs and worse with neck movement then I think surgery would be the best option. Other options would include cervical traction with a physical therapist and selective nerve root injections around the affected nerve root causing your upper limb pain. However if the pain is mostly axial in nature then see a specialist to ascertain whether your neck symptoms would benefit from radiofrequency ablation of the medial branches.




Vinod:
Last week I had a CT scan due to back pain and numbness in legs (down from knees). The report showed:

• L5-S1 -posterior disc bulge noted with thecal sac indentation. Mild endplate sclerosis also noted.
• L4-5 -Mild posterior disc bulge noted with thecal sac indentation.
• Vessels: nil significant.
• Abdominal wall: nil significant.

What can I do? Is it curable by medicine/operation/exercise, or will exercise further complicate things? How serious is my condition? I am 25 years old.

Dr. Patel:
These findings you mentioned are preexisting, meaning age-related. However some of these findings may be causing your active symptoms and some structural findings may not. Remember an MRI does not detect pain just abnormal findings or normal findings. None of these findings are curable. However stem cell research could help cure some of these findings. You should see a spine specialist that specializes in physical medicine and rehabilitation and interventional spine procedures to help develop an approach to stabilize your active symptoms that is pragmatic and realistic.




Layla:
I have disc prolapse between lumber vertebra 4 & 5. I cannot walk because of the pain. Do I need surgery and what is the downside of surgery? I'm also fat -- my weight is about 130 Kg, and I am 52.

Dr. Patel:
If you have a disc prolapse at L4-5 and you have significant pain down the side of your leg it is most likely the L5 nerve root that is affected. If you did not get relief with therapeutic selective nerve root injections around the affected nerve root causing your leg pain, then I would recommend a decompressive laminectomy and microdiscectomy. Possible issues are reherniation which can occur and the development of granulation tissue around the nerve root which can cause permanent nerve root pain.




Umesh Rao:
I have a slipped disc and for the last 2 months I have used Nervigen-p tabs. For 3 weeks my pain has reduced by more than 80%. I had pain in my lower back, butt, thigh, and a little burning sensation in my right leg. I am a cricket player - can I start playing cricket again?

Dr. Patel:
Yes. Did you have an MRI of the lumbar spine? Was the pain down the right leg posterior, buttock, thigh, and calf? If yes, then you most likely have a herniated disc to the right at L5-S1 causing an S1 radiculopathy. Make sure you strengthen your ankle plantar flexors and hip extensors if the above information is correct.




Subhash:
I have suffered from spinal pain for the last 2 years. MRI says diffuse disc bulge at L5 S1. I have seen many doctors but no relief.

Dr. Patel:
If you’re having low back pain, worse with lifting and sitting, it is most likely discogenic in nature. The only thing that helps with this is lumbar traction and improved hamstring flexibility with the supine position. Lumbar fusion for low back pain is an option but can lead to adjacent segmental pain. Transforaminal epidural injections are an option for your axial symptoms.




Sajjad:
I have disc level straightening of dorso lumbar spine with loss of normal spinal curvature, muscle spasm, disco vertebral degenerative change at L4-5 and L5-S1. Mild distortion of cauda equina nerve roots with mild enhancement of few nerve roots suggestive of non specific post operative change.

Dr. Patel:
If you are having a lot of pain from the buttock down the legs then it is possible that the enhancement is causing your pain. This is a finding that can occur after spinal surgery. A potential option is a dorsal column stimulator or selective nerve root injections.




Abdul Kader:
I have neck pain and the doctor asked me to use a cervical collar. Can I use this soft cervical collar while sleeping?

Dr. Patel:
Yes.




Bert:
Do SI joint problems cause lumbar spasms as well as the SI area pain?

Dr. Patel:
Pathophysiology behind the pain related to sacroiliac joint pain is perplexing. Some have proposed inflammation, bone turnover, micromovement across the sacroiliac possible mechanisms for causing pain along the sacroiliac joint area. Lumbar spasms in the lumbosacral region can occur.




Sathia:
Hi. I will be 65 this year and am a long-term diabetic on insulin. A few months back I developed severe neck and left shoulder pain traveling along the left arm with occasional pins/needles. I went for Physio treatment where they manipulated my neck and left shoulder, and then all of a sudden I couldn't lift my left arm above the shoulder. I am a left hander and this has caused severe lifestyle changes for me. MRI and CT scan show that I have Foraminal stenosis most marked on the left C4/5 level and on the right at C3/4 and C4/5 levels.

Dr. Patel:
You probably have a left C5 radiculopathy from the foraminal stenosis on the left at C4-5 and need a left C5 transforaminal epidural steroid injection under fluoroscopic guidance. If you fail to improve along with cervical traction, consider surgery.




Theo:
In 2012 I had a fusion of L4 and L5. My left leg is burning and perineural fibrosis was diagnosed. I cannot sit in a car or lay on my back. I am on Lyrica medication and the pain is even going to my testicles. I am desperate for help as 5 neurosurgeons advised me that there is nothing they can do to relieve the pain. The one doctor proposed a spinal cord stimulator. Do you have any advise because I am depressed and in serious trouble. I am a 58 year old male. I still work as a commercial attorney. I am standing most of the day because I can hardly sit without severe discomfort and pain. Is there any help for my condition??

Dr. Patel:
Get the spinal cord stimulator trial. This intervention was developed for radicular pain secondary to perinerual fibrosis.




Natalya:
After no exercise for a year, in May 2013 I started intensive exercise on a stepping machine while pulling rubber bands with my hands. A burning pain started in the upper right crack area of the buttocks (coccyx) and I couldn’t sit without pain. Doctors explained it as my old herniated disc L4-L5, since it is the only injury that is shown on my MRI. After two weeks I turned myself upside down on an inversion table to stretch the spine and the pain went into my right leg. But these pains were different: they were scattered all over the back of the right leg and I felt like rubbing my leg to get rid of pains. Anti-inflammatory or steroid pills didn’t help. In July, after being treated by a chiropractor’s DRX-900, the pain subsided and a second MRI showed that the hernia doesn’t press the nerve. I increased exercise and rode a bike. The pain reoccurred in the same right side of upper crack area and in the leg, like from the start. Any physical therapy directed on the herniated disc didn’t help. I again managed to heal practically to no pain in September and was advised by my doctor to increase exercise on the bike. The pain in right coccyx, low back and leg again came back from the start. I couldn’t sit, walk, or stand for nearly six months. By November the pain reached my right upper shoulder.

Deep tissue massage released the pain on the right side from top to bottom. The herniated disc diagnosis was wrong. My condition meanwhile became chronic. I understood that I have fibromyalgia. After 2-3 weeks of almost daily massage and muscle relaxant Amrix, I was sitting on any surface without pain. I started yoga and that was helping a lot. At Christmas I had to walk a distance and discovered that I still couldn’t walk -- the pain was coming into two spots in low back: right upper coccyx, and on a spot on the right upper sacrum which were referring little pains into my right leg (primarily around the lower back of my thigh and calf). Then I made some movement that reinjured my coccyx pain and I couldn’t sit again without pain.

Massage once a week didn’t help with the pain from sitting after 1.5 month till now. I still can’t walk without growing pain in either of two spots: right upper coccyx or right upper sacrum. Aching of the rest of the low back is coming from there. I have no problem with sitting down or getting up, but I have low back problems with bending down and straightening up.

I visited a lot of doctors and nobody can give me an answer. The way I injured myself in May and further symptoms tell me that I may have injured the piriformis muscle or coccyx ligaments or SI. I excluded SI joint since it makes it easier for me to sit on either of the sides, not just on the left one; I don’t have hip pain and SI exercises only hurt my coccyx spot. I also have deep vaginal discomfort that usually refers to coccyx injury. My coccyx might have been vulnerable due to the coccyx injury 13 years ago. But the majority of the physical therapy exercises for these symptoms are causing pain. The pain in my shoulder is almost gone. Fibromyalgia doesn’t bother me as much and the pain in my coccyx and sacrum are much less if I wear heating patches from top to bottom.

My low back hurts when I get up in the morning until I massage it. My muscles are soft now. I constantly apply home massager, professional massage, heat, sometimes cold. Ibuprofen doesn’t help, but Valium eliminates the pain completely and I can sit with without pain, but still with some discomfort deeply in vaginal area. Massage straight on the sacrum spot stops its pain, but massage straight on the right upper coccyx doesn’t stop this spot pain. Is it injury of coccyx ligaments and a trigger point in sacrum? But both of them stop pain after valium ..?

I have done MRI of low back, sacrum, bone scan, EMG for right leg nerve, X-ray of low back and coccyx - they are all normal (except my old herniated disc L4-L5). What is my problem and how do I get rid of it? Thank you in advance.

Dr. Patel:
I think the pain is emanating from the sacrococcygeal joint or the ligaments support this area. If you are having pain along your tailbone region primarily especially when you are sitting I would consider a ganglion impar injection or therapeutic sacrococcygeal joint injection.




Vinay:
MRI report of cervical spine showed: at C6 C7 level, dessicated disc with diffise disc bulging with broad based diffuse disc bulging L>R. Thecal sac indented . Mild narrowing of the left nerve root canal. Please advise treatment.

Dr. Patel:
Start with cervical traction. If no improvement, then consider cervical transforaminal epidural injection. If no improvement, consider surgery.




Peter:
I am a 53 year old male, 61kg ,167cm height, working as an engineer. I have been diagnosed with diabetes, cholesterol and hypertension, but all are controlled. I feel numbness in my right leg and toe when I am driving for 20 minutes. It comes on suddenly and I can' t drive - I have to stop and massage the calf muscle before it calms after 3 minutes. During long drives I have some lower back pain. Is there any physical exercise to strengthen the blood circulation to the leg?

Dr. Patel:
It is possible that the S1 nerve root is irritated. I would get an MRI of the lumbar spine. If there is no evidence of a disc prolapse at L5-S1 consider an S1 nerve root injection. If MRI is negative consider other pain generators. This would include piriformis syndrome, sacroiliac joint pain syndrome, or diabetic radiculitis.




Melinda:
I will be having L3-L4 L4-L5 and L5-S1 level stabilization PLIF surgeries. I just want to ask how long is the rehabilitation for such a big surgery, and what work is recommended after surgery?

Dr. Patel:
Recovery time can take 3 to 6 months. Muscle along the lumbar paraspinal will weaken as a result of the surgery. The risk of adjacent segmental pain is very realistic. I would ask the surgeon about recovery time. That is also dependent if there are complications.




Melinda:
1. L4_L5-Central and bilateral foraminal zone and left subarticular disc protrusion with Bilateral neural foraminal compromise upon bilateral traversing nerve roots (L>R) and mild secondary canal stenosis.

2. L5-S1-Right subarticular and foraminal zone disc protrusion with compression upon right traversing and exiting nerve roots and mild indentation upon left nerve roots.

Dr. Patel:
Not sure what you are asking here. If you have severe leg pain down the front or side of the leg have a transforaminal epidural around the affected nerve root. If you fail to progress consider surgery.




Judy:
After sitting for a couple of hours, I have a great deal of pain the next day or so in upper hips on both sides of spine around waist areas. Pain does not stop until I have been in bed for several days. Also I cannot sit for more than a few hours without pain. I have pain in my leg and end of spine when I have been on my feet for a long period of time.

Dr. Patel:
This could be sacroiliac joint mediated pain. Consider manipulation for a few sessions. If you fail to progress, consider pelvic stabilization program. If you fail to progress, consider therapeutic sacroiliac joint injection. If you fail to progress, consider a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive, then consider minimally invasive sacroiliac joint fusion.




Lucretia:
I've been having lower back pains; sharp spasms in the lower right area of my back; tingling, numbness and sharp pains in my left arm; pains in my right leg; now my left leg is becoming painful after a slip and fall accident in January 2011. MRI results show I have degenerated disc, etc. Also, that I need to have a Lumbar Scatro Fusion done. I'm in constant pain with lots of spasms, and can't take it anymore. Please can you tell me what that is and if my symptoms are related to having that done??

Dr. Patel:
What were the exact findings of your MRI? If you have a condition called spinal stenosis at L4-5 and or L5-S1 and have not done well with transforaminal epidural injections consider decompressive laminectomy with lateral recess decompression with spinal fusion for stabilization.




Leah:
I had my son 11 years ago and ever since then I have moderate to severe lower back pain especially on the right side. It feels like I need to be pulled apart like a flexy/bendy straw. When I bend down for an amount of time it hurts to stand back up. Hope this is enough information.

Dr. Patel:
This could be sacroiliac joint mediated pain. Consider manipulation for a few sessions. If you fail to progress consider pelvic stabilization program. If you fail to progress consider therapeutic sacroiliac joint injection. If you fail to progress consider a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive, then consider minimally invasive sacroiliac joint fusion.




Michele:
In 2007 two men fell on top of me, one was 300 plus pounds, and the other 180 lbs. They fractured my pelvis in three places. I was hospitalized for a week until I could use a walker to get around. I was unable to walk for over 3 months. When this all happened I complained of back pain but was told we had to wait for my pelvis to stabilize before we could deal with my back. When my back was finally addressed they found I had a herniated disc. In 2008 I had a lumbar fusion L3-L5. It did not fuse so in 2009 I had to have another fusion, this time L2-L5. I continued to have pain and complained about buttocks, hip, pelvis and leg pain and weakness. I cannot sit, stand or walk for any length of time; my only relief is to lay down with heat and meds. My family has to drive me places so I can lay back because if I drive for more than 30 minutes I can barely walk. During the first fusion the surgeon nicked the L4 nerve so I believe that's what they attributed the pain in my left leg to. Physical therapy only made my back hurt more so we stopped. In 2010 we removed the hardware because I was getting pain from it. It wasn't until 2010 my SI joints were even on the radar and were found due to my constant complaints to my pain management doctor. We started trying injections but they never lasted long and the best relief was when the novocaine (or whatever they use to do the procedure) was in me. After all these years I wonder if my SI joints weren't the problem all along due to my initial injury. I was told by my surgeon there was nothing more he could do for me and that I had failed lower back syndrome - worst day of my life to hear I will be in pain the rest of my life. However, that surgeon never once looked into or mentioned my SI joints which I believe may have been the problem all along and was missed due to finding the herniated disc on my MRI. My question to you is: even though I have multiple pain generators, due to surgeries (i.e,, scar tissue, muscle spasms, arthritis, trigger points, etc.), can both SI joints be fused at the same time (I have pain in both, but the right is worse and I get electric type zingers in the right) and would the items listed above start to work themselves out after the surgery or would they be worse due to non-weight bearing for 8 weeks? Also, would fusing my SI joints cause the joints at the bottom of my fusion to become a problem? Also, I have a sister who had the regular SI fusion and have read of people being in more pain afterward with both types of surgeries. Is there a better chance of having a successful outcome with a particular person or situation? I'm sorry for the novel but before jumping into anymore surgeries I'm doing my research. I know there are always risks but if I had done half the research I am doing now before my first lumbar fusion I might not be in this horrible situation, in constant pain 24 hours a day. Do you have any suggestions as far as what to ask my doctor when I see him next?

Dr. Patel:
Based on the fact that the novocaine injection was positive when put into the sacroiliac joint I would consider a minimally invasive sacroiliac joint fusion. Get the worse side done first then wait a few months and then get the other side done.


February 2014

Deepay:
I had an annular tear at L5-S1 and L4-5 bulge three weeks ago, and have gone to the chiropractor who tried to get the disc better. Then I did an MRI and am now going for physiotherapy sessions. Will my back be ok and how long will it take to be normal as I need to travel overseas.

Dr. Patel:
I would recommend lumbar traction and improving your core strength and hamstring flexibility only in the supine position. Most of the time this combination of treatment should help with the pain.




Amy:
I am scheduled for this procedure next week. My rheumatologist wanted me to cancel the surgery because she is 1) unfamiliar with it; and 2) thinks she should have a chance to "fix" the problem.

She is convinced I have Ankylosing Spondylitis however my neurosurgeon doing the surgery did not really say for sure. I am a difficult case because my SI and pelvic misalignment is mostly trauma. I had a bad pelvic fracture and SI separation over 20 years ago and have had several injections, PT and oral steroids as well. Even my rheumatologist says no injections or PT will fix the type of misalignment I have. She wanted me to postpone my surgery so she could try methotrexate, then move up the ladder to the bigger ones like humira. NOW she gave me the option of having the surgery then waiting and seeing her a month after to start therapy as I do have other joints involved. I have had no clear answer on this....Is the IFUSE SI BONE ok to use in a patient with a traumatic...SI degeneration with subchondral cysts even (small) with the left hemipelvis elevated. Is Ankylosing Spondylitis a contraindication to having the surgery? I do not want to wait and do want this done...I have suffered SO long I feel her modalities can wait....I have tried so many conservative measures it is crazy. The Ankylosing Spondylitis is a newer diagnosis for me so I was unclear when I left the surgeon and the Rheumatology clinic if it was contraindicated. I am also calling and asking the same questions of my neurosurgeon in the morning but wanted to see if one of you had any reason to believe I should NOT have this surgery if I indeed have AS. Thank you for your time!

Dr. Patel:
If you have the diagnosis of the anklosing spondylitis and the medication that the rheumatologist recommended does not help with your sacroiliac joint mediated pain then I would recommend the sacroiliac joint fusion using the IFUSE product.




Shawn:
I was given a fusion at the L5-S1 in 2005 -- I had pain down both legs to my feet , The fusion was done on the left side only. Today I have pain in the right leg only and have been dealing with this pain since 2008, when the pain got so bad they found that the SI point had slipped and my right leg is shorter by almost 1 inch.

1: Has having the fusion of the left side affected/ compromised/accelerated my problem on the right side?

2: By having fusion to both sides, would that have minimized my SI joint problem?

Dr. Patel:
With regards to questions 1 and 2, I am not sure. This could be sacroiliac joint mediated pain. Consider manipulation for a few sessions. If you fail to progress consider pelvic stabilization program. If you fail to progress consider therapeutic sacroiliac joint injection. If you fail to progress consider a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive, then consider minimally invasive sacroiliac joint fusion.




Teeyah:
I don't get pain all the time, only when I go to lay down I get this burning sensation that hurts and I just try moving it slowly and then it just disappears.

It also sometimes happens when I'm standing in a position and I go to move but it feels like it just locks up and I have to move slowly out of it or until the pain goes away.

Dr. Patel:
This could be sacroiliac joint mediated pain. Consider manipulation for a few sessions. If you fail to progress consider pelvic stabilization program. If you fail to progress consider therapeutic sacroiliac joint injection. If you fail to progress consider a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive, then consider minimally invasive sacroiliac joint fusion.




Linda:
What is MBB?

Dr. Patel:
Medial branch block. It is a procedure where an anesthetic only is placed on the medial branches. If your pain reduces significantly then consider radiofrequency ablation.




Rupinder:
I would like to know the meaning of my MRI report and its solution options. It says: grade 1 anterolisthesis of L5 over S1 with diffuse disc bulge causing mild indentation of anterior thecal sac, bilateral neural foraminal narrowing with mild impingement of bilateral traversing nerve roots.

Dr. Patel:
If you have low back pain it is possible that the anterolisthesis at L5-S1 could be the source. If your pain is mostly along the side of the legs, worse with standing and walking, then the neural foraminal stenosis at L5-S1 could be the source of the pain.




Joan:
I had a radio frequency lumbar 5weeks ago with no relief of pain. My pain management doctor now says there’s nothing else he can do. Is it to soon to ask for a referral to get a pain pump? I have a progressive, fatal lung disease, bronchielasis, sciatica, and back pain from arthritic discs that have collapsed. Thanks.

Dr. Patel:
Not sure what is the best option for your case. Pain pump and dorsal column stimulator are 2 options.




Hema:
My older brother has problem of C-C3 nerve compression which gives him stiffness in his back and in turn affects coordination in his leg and hand. He has had two surgies for this, the first in 1987 and the second in 1997. Since 1997 he has been fine and recovered fully and has been working 12 hours a day. But the last few months the compression seems to have returned. In the 1997 surgery a steel part was implanted in the neck. He is looking for a permanent solution to this problem – I am sure in the last 15 years technology must have improved.

Dr. Patel:
Surgical technique has improved. Unfortunately additional surgery may be the best option based on the fact that he has visual evidence of cervical cord compression. This could explain the coordination in the leg and hand. See a neurosurgeon.




Muralikrishna:
My mother is 85+ age. She was a chronic bronchitis patient for over 50 years. We believe that during one of the treatment sessions she developed an RA problem. Now she cannot walk and is dependent on a wheel chair. Her back is now humped and her legs and hands move freely, but she cannot walk. Any advice?

Dr. Patel:
Gait therapy with a physical therapist. If she has RA does she have a rheumatologist? This is very tough and the suggestions are limited. I would recommend an appointment with interventional pain specialists to evaluate if she has cervical stenosis or some spine condition that could cause this progressive decline.




Christina:
I had Lumbar Spinal Fusion performed 2 years ago and there has been no pain at all. But about 2 months ago I started to get severe Sciatic Pain down the right leg and couldn’t sit, stand, walk, etc, I had pain killers, TENS therapy, and lately the pain has eased, but is still painful at times. Could this be related to the Hardware ????

Dr. Patel:
This could be sacroiliac joint mediated pain. Consider manipulation for a few sessions. If you fail to progress consider pelvic stabilization program. If you fail to progress consider therapeutic sacroiliac joint injection. If you fail to progress consider a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive, then consider minimally invasive sacroiliac joint fusion.



Hazel:
Would I be a candidate for the rhizotomy procedure? I have facet joint hypertrophy in lumber spine at L4/L5. There is a left paracentral disc bulge causing marked attenuation of the left neural foramen. The disk is abutting the left L4 nerve root in the distal left neural foramen and far left lateral region. There's disc extrusion at L5/S1 with disc extending beyond exterior longitudinal ligament. The disc is impinging on L5 nerve root in far lateral region and also causing impingement on descending S1 nerve root in left lateral recess.

Dr. Patel:
If you are having low back pain primarily, especially worse with standing and walking, and respond favorably to a diagnostic lumbar medial branch block at L4-5, then consider the radiofrequency ablation procedure.


January 2014

Motunrayo:
Hello, Dr. I am 30 years old and I can no longer walk upright without feeling pain in my lower back. I have had a series of scans like MRI, Lumbar scan, CT scan and others, yet I still can't walk normally like before.

Dr. Patel:
If you have pain with standing and walking and it is along the low back region it is possible the facet joint could correlate with your symptoms. Consult with an interventional pain management specialist to ascertain whether diagnostic lumbar medial branch blocks would be an appropriate next step. If yes and positive for at least an 80 percent reduction of your concordant back symptoms with provocative movements, then the treatment would be radiofrequency ablation of the medial branches at the segmental levels causing your painful symptoms.




Hema:
What is the surgery preferable for Lumbar Facet Arthritis?

Dr. Patel:
Radiofrequency ablation, which is typically performed by interventional pain specialists.




Denise:
My wife had this problem for a long time and she had some injections 4 days ago. When will they begin to work, and for how long?

Dr. Patel:
Not sure what type of injections she had.




Christina:
For the past 5 days I have had excruciating pain in my thigh. It started in the lower back and went into my thigh. I basically can't sleep ,sit, or bend, and I have numbness in my thigh. I went to a chiropractor and he adjusted me and I have another appointment tomorrow.

Dr. Patel:
It could be early signs of an S1 radiculopathy or simply referred pain from the disc in the lower lumbar spine. I would recommend avoiding any bending. See a physical therapist for lumbar traction and if no better with NSAIDS consider an MRI of the lumbar spine. If the MRI of the lumbar spine demonstrates a lumbar disc displacement at L5-S1 then a transforaminal epidural is a good option for these symptoms.




Roberto:
I suffer from consistent lower back pain and have had injections in my back but still suffer from it and also suffer from a nerve pinch in the left side of my leg.

Dr. Patel:
If you have not responded favorably to lumbar transforaminal epidural injection for the left leg pain see a surgeon to see what options are available.




Melissa:
I have been given a diagnosis of SI joint dysfunction and sacroiliitis. Two days ago, I had both lidocaine and a steroid agent injected bilaterally into my SI joints. The first 6 hours or so, I was completely pain free. I was even able to drive my manually geared car the following day, something that I was not able to do for a long time. However, this morning, my pain is very severe in my SI joint area, sacrum and I also have radiculopathy going down into my toes. This pain is even worse than before I had the injections. Is it possible that the steroid simply did not work and I have a mechanical problem in my SI joint. What do you suggest? I am very hesitant to get another injection at this point considering the amount of pain I am in. Could this have aggravated an undiagnosed case of arthritis? Any advice or help you can provide would be great.

Dr. Patel:
To be sure, I would have anesthetic placed only into the sacroiliac joint bilaterally; the steroid mixed with anesthetic is not diagnostic. The relief you received could simply be a steroid effect. If the anesthetic into the sacroiliac joint provides the same type of relief then consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Lisa:
I have been suffering with lower back tightness for one year, and every night I get severe leg pain which keeps me from sleeping at all. I feel tingling, like pins and needles in the leg and hand and shoulder of left and right side nerves and it started on the left side of the face also (cheeks, forehead, and chin). Upon seeing my x-rays, the doctor said I have sacroiliitis so he prescribed gabapentin and amitriptyline 300 mg. The pain did not reduce and is increasing daily.

Dr. Patel:
If you don’t improve my recommendation is diagnostic sacroiliac joint injection under fluoroscopy using anesthetic only. In the first 4 to 6 hours you notice a significant reduction of your concordant symptoms with provocative activities using Marcaine. If positive, then consider corticosteroid instillation of medication into the sacroiliac joint. If you fail to progress consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Amanda:
I have a question about a mountain bike injury where I suffered a blow to my left iliac crest and part of my lumbar spine. I have had severe back pain ever since in the iliac crest and lower back. Three years after this injury I was assessed by a Neurosurgeon who said I would be a good candidate for disc arthroplasty at l5s1. The disc has been replaced now for two years and my spine had healed up pretty well, but I'm still left with SI joint pain which has not been addressed. I have been told about SI joint surgery but there are very few doctors here in BC Canada that know about this procedure and injury. If you have any information it would be greatly appreciated.

Dr. Patel:
See an interventional pain specialist by the name of Steven Helper, MD. He can perform the appropriate diagnostic injections that will help validate if the residual symptoms are emanating from the sacroiliac joint. If positive, you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. If you fail to progress consider minimally invasive sacroiliac joint fusion.




Geraldine:
I have been told that I have 2 nerves gone in my lower back. Would I need surgery for this?

Dr. Patel:
It is a distinct possibility.




Dixie:
I broke my sacrum and tail bone about 3 years ago and had cement put in my back twice. The pain in my right leg is unbearable. X-rays showed I had moderate arthritis in my hips. I received epidural shots in my groin area (both legs), and the pain worsened and went from my right leg to my left leg with a vengeance. I was then sent for an MRI which read that I had spinal stenosis. The neurosurgeon I was referred to said it was bad and that I needed surgery which was performed on 8/22/13 but I’ve gotten no relief whatsoever. They said my only remaining option was PT, so I asked about pain management. PM gave me three epidural shots which did not help. I am thinking about seeing another neurosurgeon here in the Roanoke, VA area. I feel as though I have sacroiliac, and I am inclined to believe that is what is wrong with me. The left leg is now so bad that I can no longer walk.

Dr. Patel:
It seems this is most likely a symptomatic spinal stenosis issue. However, to put your mind at ease in progressing toward spinal surgery, have a diagnostic sacroiliac joint injection performed under fluoroscopic guidance using anesthetic only. If you do not notice any significant reduction, then get the spinal surgery. If the diagnostic sacroiliac joint injection is positive then consider a minimally invasive sacroiliac joint fusion.




Ashish:
I have buttock pain. One doctor has diagnosed it as Coccigodiania. Previously the pain was localized but now I experience pain in the entire hip region. Can you help me out?

Dr. Patel:
Have an interventional pain specialist perform the appropriate diagnostic injections that will help validate if the residual symptoms are emanating from the sacroiliac joint. If positive, you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. If you fail to progress, consider minimally invasive sacroiliac joint fusion.




Faisal:
My father is suffering with neck pain. A doctor advised surgery after an MRI and CT Scan. We are not interested in surgery. Kindly guide us how he can improve with medicine or a different doctor.

Dr. Patel:
See an interventional pain specialist to ascertain whether a diagnostic cervical medial branch block would be a useful next step. If positive for a significant reduction of your concordant neck symptoms with provocative movements then consider radiofrequency ablation technology to treat the cervical symptoms.




Adrienne:
I recently had all the symptoms of SI Joint dysfunction - couldn't roll over in bed, getting up from seated positions was excruciating, sitting down was also excruciating, walking was tough, getting in and out of the car was tough. I had pain in my upper glutes and hips and even pretty bad plantar fasciitis. The only relief came from lying down after my back settled. My doc didn't know what to tell me so sent me to a physiatrist. In the interim, I developed fairly severe anxiety and post partum depression because I couldn't be with my baby as I wanted to be. She is now 5 months old. I was prescribed Clonazepam (.25 in the a.m., .25 in the afternoon, and then .5 at night) for the anxiety and insomnia and was also prescribed Cipralex (I am building up to 10 mgs, and am very sensitive to side effects). Both doctors have said that these drugs in no way could cause any pain relief. Anyhow, my back pain is now greatly reduced and I really want to believe that it is simply healing, but I know that these drugs can also be used for pain. I still have my foot pain, knee pain, some hip pain and pain in my finger joints but the SI area is really very much reduced. The physiatrist has said that in no way is it possible that Clonazepam could hide SI joint pain nor could the Cipralex, but I see in many discussions there are indications that these meds are used for pain and in some people quite successfully. I want to be off of these meds ASAP, but I also want to know if a) they could be working on my pain issues and, b) is it just masking the pain if they are or would there potentially be any healing? I have a bone scan set for Feb. 4 and I am still waiting for an MRI. No one can tell me what was wrong and now on the meds my pain is so reduced I don't know how to get help. What would you suggest?

Dr. Patel:
Have an interventional pain specialist perform the appropriate diagnostic injections that will help validate if the residual symptoms are emanating from the sacroiliac joint. If positive, you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. If you fail to progress consider minimally invasive sacroiliac joint fusion.




Steve:
Are there troubles with adjacent joints after fusion surgery?

Dr. Patel:
Yes. Above and below potentially.


December 2013

Shakopee:
I had c1-c4 nerves burnt from my neck. It’s been a few weeks however the pain is awful (burning) and the back of my shoulder really hurts. There is almost like a surface numbness and it is very itchy. The pain is deep in back of my shoulder. I also have been sleeping a lot since I had this done. Can you explain what's going on??

Dr. Patel:
Yes. The medial branches are undergoing a process called Wallerian degeneration. The side effects are from the ablation procedure and should resolve within 4 to 6 weeks in most patients. If they don’t, consult with your pain specialist.




Lebo:
I have a drop foot due to an accident 1996 where I broke my c4. I am limping, and it is getting worse as I grow older.

Dr. Patel:
See a neurosurgeon.




Siraj Kasim:
I am a Sryingomellia patient and have been suffering from this disease for the last 10 years. I am taking 400gm of Nerontin painkiller twice a day. In the last two years I’ve lost muscle strength in my hand and it is quite weak. It is getting difficult to sign my name. An MRI has not found any more changes and the doctor has told me to go for surgery, but I know the risk factors so I am postponing. They said I need a shunt to fix my spine. Please give me your advice and suggest a good hospital in India.

Dr. Patel:
The shunt is a must, especially if the syrinx is expanding. Spine Surgery of India in New Delhi is an excellent option.




Savita:
Yesterday I received an epidural steroid injection from a spine surgeon. What kind of precautions should I take regarding diet and exercise? Can I go to the gym and workout on the treadmill? I am living on the fourth floor – can the stairs be dangerous for my back?

Dr. Patel:
Restrictions should be only for the activities and positions that exacerbate your symptoms. No dietary restrictions. Exercise recommendations are dependent on the etiology of your symptoms. Did you have the epidural under x-ray for spinal stenosis pain or herniated nucleus pulposus?




Jeffrey:
In 2008 I was diagnosed with calcification of the SI joint right side. In 2013 I had injections but they didn’t last and which seemed to really aggravate the joint. Now the pirformis muscle stays tight. I tried therapy, exercises and a sacro wedge with no relief. Walking is difficult due to leg shortening and constant pain. Would a belt help or should I go for I-fuse?

Dr. Patel:
Have an interventional pain specialist perform the appropriate diagnostic injections that will help validate if the residual symptoms are emanating from the sacroiliac joint. If positive, you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. If you fail to progress, consider minimally invasive sacroiliac joint fusion.




Jennifer:
I have horrible pain in my sciatic joint when it flares up. Icing helps somewhat but it takes a long time. I have had cortisone injections which don't last and have seen physical therapists and that doesn't work either. I feel like I will have to live with this excruciating pain for the rest of my life. When it flares up, I am absolutely miserable and at my wits end. I keep being told by doctors to strengthen my abdominals. But how am I supposed to do that when I'm in so much agony? Is there any kind of procedure that can relieve me of my pain? I keep being told that I don't qualify for surgery because the pain isn't in my leg. I can’t live this way much longer.

Dr. Patel:
Have the interventional pain specialist perform the appropriate diagnostic injections that will help validate if the residual symptoms are emanating from the sacroiliac joint. If positive, you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. If you fail to progress, consider minimally invasive sacroiliac joint fusion.




Michelle:
I am 45, female, with mostly right-sided SI joint pain but some left side also. In November 2012 I had the iFuse Implant System done on the right side. I still have no relief from the pain a year later. I have the same pain I had before with pain in my butt, groin, legs, calves, and feet. Also, my feet get cold when I am in pain. My doctor did the injection first, and I had relief so we went ahead with the surgery. I had to stay in the hospital a few days after the surgery because the pain was so bad. Do you have any idea what could be going on? My doctor is at a loss. This Friday, Dec. 13th, he is going to do the injection into the joint again to see if there is any relief and is thinking about either adding another rod or fusing the joint altogether. Please let me know what other questions you might have or any ideas on why the iFuse didn't work. I also was diagnosed with RA about 5 months after the surgery. Don't know if it is relevant or not. Right now I can't do much of anything between the chronic back pain and the RA. I am hurting all the time very bad, I am pretty miserable.

Dr. Patel:
If the diagnostic sacroiliac injection was positive and the IFUSE surgery was negative for significant relief, the one explanation is the sacroiliac joint fusion has not fused. Did you get a CT of the pelvis to see if there is any evidence of fusion at this point? The other issue could be the facet joint at L5-S1 could be the source of the pain. Have that structure evaluated with a diagnostic lumbar medial branch block and if positive consider radiofrequency ablation.




Melwin:
I have undergone L5-S1 spinal fusion for spondylolisthesis for having unbearable burning sensations at my lower back on May 11, 2011. They did a bone graft and screw fixation. My recovery was very slow and I took almost 3 months to walk. The 4th month I went back to work as I am a software professional. I did manage to bear pain after post surgery. Now I feel a different type of pain and I am not able to sit for little long; laying down does give me some relief. My question is: why do I have pain even after surgery? Should I have more tests and consult a different doctor for further feedback and precautions?

Dr. Patel:
Have an interventional pain specialist perform the appropriate diagnostic injections that will help validate if the residual symptoms are emanating from the sacroiliac joint. If positive, you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. If you fail to progress, consider minimally invasive sacroiliac joint fusion.




Eileen:
My X-ray shows marked loss of disc height at L3/4 andL4/5 with moderate degeneration change at this level. Disc heights elsewhere are preserved and there is normal vertebral alignment and morphology. Mildly degenerate sacroiliac joints.

Dr. Patel:
If you’re having pain along the lumbosacral region consider a diagnostic injection that will help validate if the residual symptoms are emanating from the sacroiliac joint. If positive, you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. If you fail to progress, consider minimally invasive sacroiliac joint fusion.




Elvita:
I had sacroiliac joint locking problem on my left side pelvis. My chiropractor did manual adjustments to both sides and my left side was back to normal, but my right side went up -- I was all shifted. Because it was uncomfortable to walk, I saw the chiropractor again and he did more manual joints adjustments. I still wasn't leveled, but the doctor said he will back me 100%. After 6 weeks I went back for more manual adjustments, but this time my right side went slightly to front and left side to back. I'm tilted and shifted. My hip bones moved up and my joints too. It sounds strange that bones can't move, but they did move up, and I’m very stiff and tight. I can't even cross my legs. The pain is very bad in my hip bones and joints and going down to my legs, and my sacro-joints in my back and low back is in pain, too. I don't know what to do? I'm a complete mess. Is it possible to get back to normal? I have even spasms in my low back and sacro-joints too. I'm on strong medications and hot water bottles. I’m just looking for good specialist who can get me back to normal (if that’s possible). I was fit and healthy all my life and I'm still a young woman of 43.

Dr. Patel:
Have an interventional pain specialist perform the appropriate diagnostic injections that will help validate if the residual symptoms are emanating from the sacroiliac joint. If positive, you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. If you fail to progress, consider minimally invasive sacroiliac joint fusion.




Glenn:
I've had pain in between my shoulder blades, mostly on my right side, for a few years. I was told that I had subluxations and had a rib or two out of alignment. I recently signed up for a "48 session chiropractic journey.” They claim that straightening the spine will allow my nerves to help the organs function better. It made sense, so I signed up and paid $2400. They only took X-rays of my neck and lower back when I signed up. Now I'm 2 months and 24 visits into my 4 month treatment and my front and rear ribs are still in pain. I can hardly do a push up. I asked the doctor why they didn't take x-rays of my center back, and they said it was a good idea, so they took some (why didn't they do this in the first place???). Today I reviewed the X-rays and they were in shock at how twisted my spine was and they won't crack me anymore, claiming that it could fracture a rib - but they've been cracking me for the last 2 months. So now what do I do? Has all this back cracking, neck snapping, etc. been a waste of my time? Did they make me worse than I was before? Who should I go see about this twist in my back that makes my ribs pop out of place so often? Should I demand my money back from this place?

Dr. Patel:
I would get an opinion from an interventional spine specialist that is affiliated with the International Spinal Injection Society. They should be competent in ascertaining which diagnostic and treatment will work the best based on evidence-based medicine.




khalid:
I have been diagnosed with a pinched nerve which causes pain in the upper part of my right leg. After an MRI the doctor prescribed to Pregabalin which I took for about 2 months and it made me feel perfectly alright until I discontinued it and the pain reappeared after one month. I restarted the same medicine but it’s not working. What do you suggest?

Dr. Patel:
At this point I would recommend a transforaminal epidural at the segmental level causing your pain. If no improvement, try with lumbar traction under the supervision of a physical therapist.




Jovi Tan:
In my MRI report for my lumbar, it shows moderate narrowing of central canal and narrowing of lateral recess and neural foraminal compromise bilaterally. It also shows a bulging disc. What is the best solution for this problem?

Dr. Patel:
If you are having severe pain from the buttock down the leg worse with standing and/or walking consider a transforaminal epidural injection and lumbar traction. If no improvement, consider surgery.




Gennette:
I have had this pain for over 15 years. It started when I had a pelvic abscess in 1998. I was initially diagnosed with sciatica by my primary care physician at the time. Over time the pain got worse. Once I was diagnosed with rheumatoid arthritis the pain became unbearable. I have had MRI's, steroid injections, ER visits and countless pain medications for the pain all to no avail. I still have not received a diagnosis!! The pain is disrupting my life and I can't be the kind of mother, wife or person I want and need to be. I have been doing research on SI dysfunction and I was hoping that you could help me. I have been seeing a neurologist who seems to think that this has something to do with the RA. My rheumatologist seems to think that the issue is with my spine. I am so tired of this pain that starts in my right buttocks and hip and goes down my leg. When I lay down on my side it hurts so bad! The pain often wakes me up in the middle of the night. I have morning stiffness, but I attribute that to the RA. I feel really desperate and don't know where to turn. I really hope you can help me!!

Dr. Patel:
Have an interventional pain specialist perform the appropriate diagnostic injections that will help validate if the residual symptom are emanating from the sacroiliac joint. If positive, you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. If you fail to progress, consider minimally invasive sacroiliac joint fusion.




Karin:
My problem is bulging discs L2 with radiating pain down in left leg. The pain wakes me up at night. I have difficulties in raising and lowering the left leg and difficulty sitting on my knees and getting up from the position.

I work as a dental hygienist full-time for more than 11 years, seeing 13-15 patients a day over the years. What can I do?

Dr. Patel:
Consider a lumbar transforaminal epidural at the segmental level causing pain and if no improvement consider surgery.




Jason:
I was injured in an industrial accident when a warehouse door fell on me and struck my shoulder, head, and back. First diagnosed as back strain, I have had pain for 15 years: burning in both legs, front side only, low to mid back pain, throbbing pain into feet, no pain in butt. I’ve been treated by pain doctor for degenerative disease, but a surgeon is not willing to operate. I’m always in pain, even with medication. I had 2 facet blocks, epidural, morphine implant, dcs stimulator implant -- nothing works. The pain is so severe I use a cane for assistance. I feel clunking, but there is no evidence of instability in mri or x-ray. At times it feels my spine and hips are squeezed in a vice. I can do minimal activity, but pain increases in areas described the longer i continue. Low heat seems to give best results.

Dr. Patel:
Have your interventional pain specialist perform the appropriate diagnostic injections that will help validate if the residual symptoms are emanating from the sacroiliac joint. If positive, you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. If you fail to progress, consider minimally invasive sacroiliac joint fusion.

November 2013

Jane:
What do I do to avoid this waist pain, and what is the nature of the pain because I don’t want to die.

Dr. Patel:
Have your interventional pain specialist perform the appropriate diagnostic injections that will help validate if the residual symptoms are emanating from the sacroiliac joint. If positive, you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. If you fail to progress, consider minimally invasive sacroiliac joint fusion.




Shelly:
HELP! My doctor is about to fuse my L4&5 and I'm sure that the problem is my SI joint. He and another doctor looked at my CT scan and said I had arthritis in my SI joint. For the past 3 years I've had increasing pain over my right buttock, going down my right hip to my thigh. I had one doctor prescribe shoe inserts because my gait is really off. I've fallen on my butt 4 times, most recently December of 2012. I've tried physical therapy, muscle relaxers, pain pills, nerve blocks, nothing has worked. My doctor wants me to decide quickly if I want the back surgery. Whatever I have done, I have to do before the end of the year due to insurance issues.

Dr. Patel:
Have your interventional pain specialist perform the appropriate diagnostic injections that will help validate if the residual symptoms is emanating from the sacroiliac joint. If positive, you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. If you fail to progress, consider minimally invasive sacroiliac joint fusion.




Monika:
I have foot drop 9 months after the delivery of my sweet daughter. I am taking pain medication but there has been no improvement. The issue started with my right leg but now both the legs are affected. The doctors say it is muscle weakness – what do you think?

Dr. Patel:
Get an MRI of the lumbar spine. If there is a herniated disc that could correlate with foot drop see a spine surgeon immediately.




Mary:
I am an RN working in an ICU/MedSurg unit for the past 22 years. I fell hard at work 5 months ago on my right side and it jarred my iliad-sacral joint. I suffered a facet joint injury. A week ago I received the Bilateral Medial Branch Block with huge success for 3 days. I am now awaiting approval from Workers Comp for the Radio-frequency Ablation. My questions are: 1) How long is the average recovery from this procedure? and 2) When I recover, I want to go back to my same job. Do you think this is ok?

Dr. Patel:
Hopefully your interventional pain specialists performed the appropriate diagnostic injections that will help validate if the residual symptoms are emanating from the sacroiliac joint. If positive, you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. Average recovery after radiofrequency ablation is approximately 2 to 4 weeks. If you fail to progress, consider minimally invasive sacroiliac joint fusion.




Stephanie:
I have had unremitting low back pain for 6 years now and due to the severity of the pain on bending forward, standing or walking I am now a full-time wheelchair user. I have been told I have lumbar degeneration at a few levels with a central disc herniation involving the superior endplate at L1 and some modic changes at L3/4 but there seems to be no surgical help available to me. Please could you tell me whether the unbearable increase in my pain on weight-bearing could be sacroiliac joint related?

Dr. Patel:
Have the interventional pain specialist perform the appropriate diagnostic injections that will help validate if the residual symptoms are emanating from the sacroiliac joint. If positive, you have options like corticosteroids injected into the sacroiliac joint and/or bipolar radiofrequency ablation. If you fail to progress, consider minimally invasive sacroiliac joint fusion.




Angel:
I had a L5 S1 Microdiscectomy 10 weeks ago on my right side but my right foot is still numb along with my right hip and thigh but my pain on my left side is 100 times worse than before surgery and the left side isn’t where my herniation was but my left leg is numb. The pain is terrible and my butt and hip shoots pain into my inner thigh.

Dr. Patel:
I would get an updated MRI of the lumbar with and without contrast to see if there is scar tissue or new disc herniation that is corroborative with your painful leg symptoms.




Carol:
I have been diagnosed with scoliosis. Could this be sacroiliac joint problem? My doctor said nothing could be done. I have lower back pain every morning for about 2 hours. It then subsides for a few hours only to return in late afternoon. Sitting contributes to my pain. Walking and swimming seem to alleviate it somewhat. I have given up most of my athletic games, dancing, table tennis. I continue to walk altho I have pain for the first 15 minutes of the walk. The doctor said to walk, but rest periodically rather than walk too long.

Dr. Patel:
Have your pain specialist perform the appropriate diagnostic injections that will help validate if the residual symptoms are emanating from the sacroiliac joint. If positive, you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. If you fail to progress, consider minimally invasive sacroiliac joint fusion.




Angela:
Every time I sneeze my neck pops and my fingers and toes go numb, I also get dizzy and my vision goes dark. What causes this? Is the tingling caused by the piping in my neck? Should this be looked at?

Dr. Patel:
I would get an MRI of the cervical spine and see if there are structural problems compressing the spinal cord.




Angela:
Hello. I am a new member of spine-health.com. My mom is suffering from left leg pain from buttocks to the foot for the last 3 years. The MRI LS spine results read:

- Transitional vertebra at LS junction with sacralization of L5
- Diffuse annular bulge at L3-L4 level causing mild thecal sac indentation
- Mild anterolisthesis of L4 over L5
- Bilateral facetal arthrosis at L4-L5 level contributing to the impingment over the lateral recess and narrowing of neural foramina
- Subtle signal changes involving the iliac aspect of right sacroiliac joint suggesting mild sacroilitis

Can someone explain the above in simple terms and tell me what is the next step to help my Mom get rid of her pain?

Dr. Patel:
If she has pain in the left hip going into the lateral thigh and lateral calf worse with standing and walking, get a left L5 transforaminal epidural injection under x-ray guidance. If no improvement, consider spine surgical intervention.




Fred:
I had a fusion on the L5-S1 and my leg pain is worse now then before I had the fusion. This has been going on for 3 years. Before I had the fusion I had two surgeries in two years. I am starting to think that the Doctor is doing something wrong. Or is it just me thinking wrong? The diagnosis is L4/L5and L5/S1 discs mild diffuse bulges without neural compromise centrally.

Dr. Patel:
Have an interventional pain specialists perform a diagnostic sacroiliac joint injection. If positive for significant relief with functional activity you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. If you fail to progress, consider minimally invasive sacroiliac joint fusion.




Nupur:
I have been working as a Physiotherapist for past 3 years in India. During my practice I have come across many patients with 'Sacroiliitis.' Most of them are software professionals. I have treated them with multidisciplinary treatment options like stretching, Ultrasound with topical anti-inflammatory agents, micro-currents, and postural corrections however, I got very few successfully treated. Could you guide me as to how I should approach these patients to give them permanent relief without leaving their profession?

Dr. Patel:
Have the patients see a specialist that can perform the appropriate diagnostic injections that will help validate if the residual symptoms are emanating from the sacroiliac joint. If positive you have options like corticosteroids injected into the sacroiliac joint and bipolar radiofrequency ablation. If that fails, consider minimally invasive sacroiliac joint fusion using the IFUSE product.




Lorraine:
I was diagnosed with minimal deterioration of my L5 and S1. My lower back continues to hurt as well as becoming “stuck” so that I cannot walk properly. I am currently experiencing pain in my lower back, buttocks, and upper legs as well as a continuous achy pain in my hips. I just keep getting told to go to the physical therapist and take pain medication. I’m tired of hurting...

Dr. Patel:
The pain could be emanating from the L5-S1 facet joint. Have an interventional pain specialist perform a diagnostic lumbar medial branch block to anesthetize the L5-S1 facet joint bilaterally. If positive for at least an 80 percent change of your concordant painful symptoms with functional activities, consider radiofrequency ablation of the L5-S1 facet joint bilaterally.




Patricia:
Hello, and thank you for taking the time to do this forum. My questions follow:
1) What is the long term success rate of traditional SI joint fixation using screws only, or what is the likelihood that the screws may break?

Dr. Patel:
This data will be available soon. Can’t comment at the moment.

2) My orthopedic surgeon has recommended that I undergo screw fixation on one side. If it alleviates my problem he then recommends undergoing a traditional fusion with screws one year later. How important do you think it is that the surgeon be experienced in doing this surgery specifically for SI joint dysfunction? They do it all the time for fractures and in the case of trauma.

Dr. Patel:
I feel minimally invasive sacroiliac fusion is a better option. Reasons would include shorter surgery time, less blood loss and faster recovery time.

3) Do you believe that the pelvis must be in the correct position at the time of fusion or fixation?

Dr. Patel:
No. There is no study to suggest this notion.

4) How common is it to have buttock and leg pain (bilateral) with SI joint dysfunction? Is this a measure of how serious your condition is? My diagnostic imaging, including CT scan of the SI joints shows nothing abnormal.

Dr. Patel:
Yes, sacroiliac joint pain can cause pain in the buttock and leg. Imaging studies can be normal in the presence of sacroiliac joint dysfunction. Diagnostic sacroiliac joint injection using anesthetic into the sacroiliac joint is the current gold standard towards diagnosis. Physical exam is also helpful with at least 3 provocative sacroiliac joint tests being positive.




Gousia:
My father is suffering from diffuse disc bulge causing thecal sac identation at L4/L5,L5/S1 causing bilateral neural foraminal narrowing and posterior osteophyte disc bulge complex at C4/C5,C5/C6 causing compression of thecal sac and spinal cord. Can u please explain what this means and what we should do?

Dr. Patel:
It means if you have moderate to severe neck and arm pain and/or severe pain down the legs, worse with standing and walking, see an interventional pain specialist to ascertain whether transforaminal epidural injections are necessary to help alleviate the symptoms in conjunction with cervical and lumbar traction.




Neerja:
I was operated on for cauda equiona PIVD in December 2012. I was fine until October 2013 but due to some prolonged standing in the kitchen or household work my center back has become stiff and I feel uneasy. After some rest I feel better but the stiffness persists. I've been doing my regular walks also. Please advise me of some remedial actions.

Dr. Patel:
I would see a physical therapist to see if certain stretches to improve pelvic flexibility will decrease your axial low back pain.




Guru Prasath:
I’m 22 years old and suffering from diffuse annular disc bulg and small subligamentous disc herniation at l3-l4 causing mild thecal sac compression and diffuse annular disc bulge and posterocentral subligamentous disc herniation at l4-l5 compressing the thecal sac and causing severe lateral recess and foraminal narrowing. This causes intense pain. After two months of continuous rest the pain is reduced to 60% and I’m doing physiotherapy exercises daily. But I’m still not able to walk freely. I’m a student and I’m unable to go for my exams. Please tell me what to do for a permanent cure.

Dr. Patel:
If you are having pain down the legs, worse with standing and walking and/or sitting, see an interventional pain specialist to ascertain whether the L4-5 foraminal stenosis is corroborative with your painful symptoms. Options to help cure the symptoms would include a transforaminal epidural injection with lumbar traction. If you fail to progress, consider an open surgical solution incorporating the lumbar spine.


October 2013

Partaud:
I have seen your name on Google. Is the McKenzie Method or surgery a better option for me?

I am a 52 year old college professor in France and I am on my feet a lot. I am active and like to run but because of back pain I have not been able to run since last August. My doctor says there is nothing he can do for me; that it will just get worse and I will need surgery in the next year or two. A scan showed a small postero-lateral dis herniation left L4-L5; denegerative disc L5-S1; incipient bilateral osteoarthritis.

Dr. Patel:
If you are having more pain along the left lower limb, worse with sitting or walking down the side of the leg into the calf, the L5 nerve root could be the source of the painful symptoms. If the low back pain is worse and is reproducible with standing/walking and/or going from sit to stand I would recommend a diagnostic lumbar medial branch block to anesthetize the zygapophyseal joints in the lower lumbar spine. If your typical back pain reduces significantly within the first four hours with functional activity then a radiofrequency ablation to denervate those medial branches is a great option.




Diane:
I had a fractured pubis and sacrum (entire sacroiliac joint) 30 years ago which was treated in a pelvic sling for a month. About 7 years later was diagnosed with chronic pain. One sacroiliac injection worked for several months, but subsequent injections at Mayo Clinic did not, with the joint being inaccessible. A bone scan did not show any unresolved fracture. Fluoroscopy during injection showed pain below the periosteum (i.e., bone pain). Would the ifuse be indicated if the pain is now in the bone itself? I do understand the unknown inervation of bone. Is there anything new?

Dr. Patel:
Unless the sacroiliac is not completely fused the pain could still be emanating from the sacroiliac joint. I would consult with a spine surgeon to see if they agree that you are suffering from intra-articular mediated sacroiliac joint pain and ascertain whether the IFUSE product is an appropriate next step to help stabilize your symptoms.




Seabron:
It’s been 4.5 years since spinal lumbar fusion and I still have chronic low back pain in buttocks and thru out legs ...is there a perm fix?

Dr. Patel:
The pain could be emanating from the sacroiliac joint secondary to adjacent segmental stress from the fusion at L5-S1. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance and if positive for a significant reduction in your leg pain I would recommend a pelvic stabilization program and corticosteroid instillation of medication into the sacroiliac joint. If you fail to progress I would recommend a minimally invasive sacroiliac joint fusion using the IFuse product.




Rajnish:
My brother reported problems walking in late summer 2013 which increased gradually and then he could not even walk up the stairs (after about 2 weeks’ time) and reported numbness in the legs (L>R). After the MRI we found that his D5-6 disc has displaced from its position causing severe cord compression and cord thinning. We consulted a couple of doctors and all of them recommended immediate surgery to remove the compression.

Shortly thereafter he was admitted to the hospital but the Head of Spine Services said that considering his age and current condition there is a chance that he could recover and may not need surgery. He was given the option to wait for 6-7 weeks and given steroids for 2 days and medicine for 11 days with strict bed rest. Then they discharged him. Currently, he is on bed rest (for over 2 weeks now) at home with bedside physiotherapy and medication as prescribed by the doctor. His condition has neither deteriorated nor is there any significant improvement in the past 2 weeks.

Should we go for the immediate surgery or wait for couple of weeks and follow the conservative approach which he is currently undergoing? Also, how much risk (both during surgery/post- surgery) we would be able to reduce if we keep the patient on bed rest (along with bedside physiotherapy and medication) for another month or so to let the muscles relax, let the nerves regenerate so that he can get some power back into his limbs and probably then go for the surgery? Will this approach have any effect at all or not on the surgery?

Dr. Patel:
He is suffering from a cervical myelopathy from the cervical cord compression which is probably the reason he is having difficulty walking. The surgery is the best option. The steroid may help to reduce the swelling but the mechanical causes of the spinal cord compression at C5-6 needs to be eliminated at this point.




Vishnu Mahesh:
I am feeling pain in my lower back down my left leg. I am having difficulty walking and am in deep pain in my low back while sitting.

Dr. Patel:
It is possible that your left leg pain is radicular in nature. I would recommend an MRI of the lumbar spine and see if there is a structural abnormality that could explain the left lower extremity pain. If the MRI is positive then I would recommend a selective nerve root block and a flexion biased spine rehabilitation program. If you fail to progress I would recommend obtaining a surgical opinion.




Ashley:
I’m having really bad neck and shoulder pain and have had two different MRIs within two weeks of each other. The first said minimal disc degeneration and a straighten in my cervical spine with no bulge, etc. The second MRI said only a mild bulge in my C6-7 with no spinal or foraminal stenosis. They told me that neither condition should cause me pain so where is my pain coming from?

Dr. Patel:
The neck and shoulder pain could be emanating from the disc and facet joint at C6-7; I would recommend seeing a pain specialist that can perform a diagnostic cervical medial branch block. If positive for a significant reduction of your typical neck painful symptoms then I would recommend a radiofrequency ablation at C6-7. If the diagnostic injection is negative then I would recommend an anterior cervical fusion at C6-7 if cervical traction fails to relieve the pain significantly.




Julie:
I had an L4-S1 lumbar fusion in March of 2012 and at 6 months post-op began developing severe right buttock and leg pain. After having 3 sacroiliac injections (all with short term relief), I had an IFUSE procedure on my right SI joint in April 2013, and went home relatively pain free the next day. Unfortunately, at 2 days post op, I was in the ER with excruciating pain down my right leg and a follow-up CT scan showed that the pin was removed and I spent the next 9 weeks in and out of the hospital for pain control & neuropathy- 6 admits and 4 ER visits. Finally Tegretol offered some relief, however for the past 2 weeks I have been having SI joint pain again, radiating down my leg to my foot- lying down, walking, sitting - all bad. I fired my initial surgeon and have been told by an orthopedic that I should have my sciatic nerve "scoped" but I cannot find anyone in Massachusetts who does that. Can you give me any suggestions?

Dr. Patel:
If an updated MRI of the lumbar spine without contrast fails to demonstrate a new structural problem that could explain the right lower extremity painful symptoms I would recommend a CT of the pelvis to see if the implant is in close proximity to L5 or S1 nerve root. If so then see the surgeon. If the CT scan is negative then it is possible the sciatic nerve is the issue from a condition called piriformis syndrome. I would recommend an electrodiagnostic evaluation of the right lower extremity. If positive for a sciatic neuropathy, then I would recommend a piriformis release.




Jonique:
I'm not sure what's wrong with my back. I have been having lower back pain since I was 12. As I got older it got worse. I am now 19 years old with 2 kids and it’s even worse. It hurts all the time.

If I was to clean the tub, I would have to stand up slowly because of the pain, or if I was to lay back I have to do it slowly. What do you think could be wrong?

Dr. Patel:
If the pain is lumbosacral in nature the pain could be emanating from the sacroiliac joint, the disc at L5-S1, or the facet joint at L5-S1 bilaterally. I would recommend seeing a pain specialist to perform a diagnostic sacroiliac joint bilaterally. If positive then I would recommend corticosteroid instillation into the sacroiliac joint. If that doesn’t help I would recommend the Ifuse procedure which is a minimally invasive sacroiliac joint fusion. However the pain specialist may recommend an MRI of the lumbar spine to see if there is a lumbar disc displacement at L5-S1.




Margaret:
I need a trained Ifuse surgeon that is experienced.

Dr. Patel:
Go to www.si-bone.com. The number to call for a surgeon in your area should be available.




John:
I am suffering from an L4-L5 disc bulge. I exercise regularly and continue to suffer pain. I have an MRI every six months and am using Gabapentin 450. What do you recommend?

Dr. Patel:
If your low back pain is most severe then try a few epidural steroid injections under xray guidance in conjunction with lumbar traction. If you don’t improve consider a spinal fusion.




Roger:
I have had a laminectomy, spinal fusion of L1 - L4, then removal of hardware lamin. of left L5-S1. With each procedure the pain increased. Would I be a candidate for the SI implant procedure?

Dr. Patel:
The sacroiliac joint could be the source of the painful symptoms. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive then I would recommend corticosteroid instillation of medication into the sacroiliac joint. If you fail to improve then I would recommend a minimally invasive sacroiliac joint fusion using the Ifuse product.




Beth:
My pain radiates from my lower back down around my rear end and my upper legs. Very badly, I want to add. I went thru months of pt and shots...then cauterization of nerve roots in my lower back two months ago. Really helped me a lot but it’s slowly coming back with the hip pains and leg pain that I kept including in my descriptions of symptoms to my physiatrist. Today I went back to see him...only to be given a butrans patch. I have another appointment to see his NP but not him.....as if I am not fixable and now just meds to cover it up. Would it be disrespectful to ask for him to consider it being my SI joint and see if he would try that shot and see if we obtain a 75% ratio of relief?

Dr. Patel:
The sacroiliac joint could be the source of the painful symptoms. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive then I would recommend corticosteroid instillation of medication into the sacroiliac joint. If you fail to improve then I would recommend a minimally invasive sacroiliac joint fusion using the Ifuse product.




Izzati:
I've noticed that my left dib is bigger than the right one (the right one is flatter). As a child, an x-ray showed me to have mild scoliosis. Up until then I did not have any back pain. I'm now 21 years old, and I notice that my back aches every morning. I always sleep on left lateral side. As a student, I stand a lot during class and on average stand for about 5 hours per day. At first during the early semester I did not sustain prolonged back pain -- it gets resolved when I sit. But now my back pain is prolonged every time I stand, and even after I sit down the pain is still there for a long time. It takes a long time for the pain to be relieved when I am supine. Do I have to see the doctor to check my current backbone condition?

Dr. Patel:
The sacroiliac joint could be the source of the painful symptoms. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive then I would recommend corticosteroid instillation of medication into the sacroiliac joint. If you fail to improve then I would recommend a minimally invasive sacroiliac joint fusion using the Ifuse product.




Roger:
I had L4 and L5 operated on 2 1/2 years ago and did well for a year and a few months before my lower back started hurting again. They operated on S1 last summer and I did real good for 5 weeks but now I can hardly get out of the chair, walk up steps, ride for very long, or bend over, and the lower part of my stomach kills me in the morning before I urinate. I just got my sacroiliac joint injections today and don’t know what to do next.

Dr. Patel:
If you had a diagnostic sacroiliac joint injection under fluoroscopic guidance and it was positive then I would recommend corticosteroid instillation of medication into the sacroiliac joint. If you fail to improve then I would recommend a minimally invasive sacroiliac joint fusion using the Ifuse product.




Beth:
I have pain in my upper legs, hips, and lower back all the time. I have been treated for bursitis of the hip with injections into each hip, and I am taking Hydrcodone, Gabapentin, and muscle relaxers, which are not much help. It is also becoming difficult to urinate, and I have diarrhea a lot.

Dr. Patel:
The sacroiliac joint could be the source of the painful symptoms. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive then I would recommend corticosteroid instillation of medication into the sacroiliac joint. If you fail to improve then I would recommend a minimally invasive sacroiliac joint fusion using the Ifuse product.




Andrew:
My sciatic nerve decompression was done in April 2013 and I’m still having pain in left hip and leg (burning, pain, numbness and severe pain). My current MRI shows normal vertebral alignment of lumbosacral spine redemonstration of circumferential disc bulge with minimally increased right paramedian component at L5 S1 level resulting in mild right lateral recess. Narrowing atrophy of left piriformis muscle is noted. I have a severe pain in my left hip and left leg when I sit. Kindly guide me what I can do for that since I’m not doing physiotherapy.

Dr. Patel:
The sacroiliac joint could be the source of the painful symptoms. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive then I would recommend corticosteroid instillation of medication into the sacroiliac joint. If you fail to improve then I would recommend a minimally invasive sacroiliac joint fusion using the Ifuse product.




Rafeza:
I found a very small opening in my son's neck after his birth. Some fluids come out from that hole. He is now 6 years old and he’s still having this. What should I do for this?

Dr. Patel:
See a pediatric neurosurgeon.




Shimoga:
L4-5, L5-S1 disc bulged focally prominent in left paracentral and foraminal region. Please help me -- I am having pain in my lower back. I am 28 years old.

Dr. Patel:
I would avoid a spinal fusion for axial low back pain. If you are having more pain in the lumbar region, worse more with standing and walking, consider seeing a pain specialist that can evaluate whether the facet joint at L4-5 and L5-S1 could be corroborative with your symptoms. I would recommend lumbar traction, inversion table, and avoid forward bending.




Wilma:
My brother-in-law went for a spinal myelogram and immediately after the procedure, he went blue in his face, his blood pressure went sky-high and his whole body contracted like he was having grand mal epilepsy. He was in a deep coma for 3 days, with epilepsy episodes. Since he came out of the coma he has not been able to speak properly and did not recognize anyone.

The doctor had an MRI scan and EEG done, but no signs of bleeding was found, only Iodine on his brain. Is this normal that the contras medium went to his brain? Will he ever recover?

Dr. Patel:
That is not a typical reaction from a spinal myelogram.


September 2013

Harekrishna:
About 7 years ago I woke up one morning with a lot of pain. The doctor did an MRI and told me I needed surgery but I declined. About 10 days ago I started feeling pain as before. Again I did an MRI and the doctor recommended surgery. I have prolapses at discs C5/C6/C7 and they are building pressure on the nerves causing pain to radiate through my shoulder.

I want to avoid surgery. Someone suggested I try Ozone therapy. Can you suggest whether I should go for that and, if so, where it is available? How long should it be taken and is it a permanent solution?

Dr. Patel:
If you have cervical radicular pain accounting for your upper limb pain and it is confirmed clinically or through other objective tests like an electrodiagnostic evaluation and correlated with your MRI of the cervical spine, I would recommend a therapeutic selective nerve root injection at the nerve root level creating your symptoms in conjunction with cervical traction. If no improvement then I would consider the surgery.




Doris:
I had lumbar fusion 6-7 and an s1-2 appendectomy in Jan of this year. Lumbar pain has completely gone, however over the last month the very low sacral pain has steadily increased. Over the last week I am having sciatica-type pain but located more in the hip and it’s worse lying down. The pain is much worse at night while attempting to sleep. It is a burning shooting pain that radiates down my thigh. The outer aspect of my thigh is very sore to touch. The pain is better while in a walking position and I am unable to stand for more than a few minutes.

Dr. Patel:
It is possible the sacroiliac joint is correlated with your painful symptoms. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive then I would recommend a therapeutic sacroiliac joint injection in conjunction with pelvic stabilization program. If your symptoms fail to progress then I would recommend a minimally invasive sacroiliac joint fusion.




Damian:
I have had an l5si protusion for 3 years now. In your opinion, can this also make the right hip deteriorate due to this injury?

Dr. Patel:
Yes. If you have chronic radicular pain accounting for your leg pain and weakness then the hip muscles can weaken and deteriorate placing more stress on your hip joints creating more secondary painful symptoms.




Talib:
I have been suffering from leg drop for the last 8 years. Is this treatable?

Dr. Patel:
I would consult with a spine surgeon to see if your foot drop is emanating from the spine. Some cases are salvageable and some are not.




Llian:
I have found the source of my pain to be from both SI joints. It comes and goes. Is always achy, but then becomes a grinding/pinching type of pain. If I lay flat (belly or back) I always need help getting up because it seems to freeze up and moving causes excruciating pain. Blood tests look normal. CT shows cysts, mild arthritis, and "bone islands" on both sides. I have been rejected from a pain specialist for care and treatment. Docs can't understand how these "mild" conditions could cause the severity of pain I am experiencing. At what point would a doctor recommend a motorized mobility device for bad days? Docs are also giving Dx of fibromyalgia. Does Fibromyalgia pain usually begin in the SI joints? How should I go about seeking a 2nd opinion and what questions should I ask? I seem to have exhausted the training of every doctor I find and no one seems to have any other specialist to direct me to. Is there a list of specialists who focus on SI joint conditions? Is it possible to Dx as ankylosing spondylitis without evidence in blood work and radiographs?

Thank you for hearing me out. I love my current doctor....he has just made it clear that I have exhausted his training and experience.

Dr. Patel:
I would recommend a second opinion with a spine specialist preferably someone who is a member of the International Spinal Intervention Society. They may feel it is a rheumatologic condition, sacroiliac joint in origin or something completely different.




James:
I have disc slip problem grade-1 L5 overS1. I am a cyclist and have pain in my lower back when i ride. What do you suggest?

Dr. Patel:
So the disc at L5-S1 is probably getting irritated from the prolonged sitting. The one thing I would try is improving your hamstring flexibility while laying on your back only. My opinion is the more flexibility in your hamstrings in the supine position the less back pain you should have while sitting.




Parikshit:
My bone scan shows I have inflammatory bilateral sacroiliitis but after seeing a rheumatologist he said he does not think I have inflammatory sacroiliitis but believes it is more mechanical. I am a bit confused -- why would a bone scan show that I have this if I don't have inflammatory sacroiliitis? Should I get another opinion? He wants to prescribe me morphine-type pain medications for the pain. Does this mean do not I have sacroiliitis?

Dr. Patel:
You have radiologic evidence of sacroiliitis if an MRI of the pelvis shows inflammation. Bone scan detects bone turnover. Unfortunately bone scan being positive does not mean the pain is emanating from the sacroiliac joint. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive, then have a therapeutic sacroiliac joint injection. If your symptoms fails to progress, consider a minimally invasive sacroiliac joint fusion.




Yessica:
My father just had an operation for cervical spine decompression fusion C4-6 and posterior lumbar interbody fusion stage 3, decompression L1,2 and fusion L5,6,S1. Now 4 weeks post-op he still has muscle weakness and must use a walker under full supervision. No power in both hands but he is able to shake your hand strong enough. Also no power for lifting up. How long will recovery take? Will he be able to walk and work again? He is 68 years old and already had CABG 2 years ago. He does not smoke. Before the operation he was still active: work, drive, swim. Now he is doing physiotherapy in his room everyday and at the gym 2x/week.

Dr. Patel:
Muscle recovery can take years with the greatest change in improvement seen within the first 12 months since surgery.




Pina:
I suffer with lower back, hip & leg pain, and I experience pins and needles, numbness & muscle spasms, which feel like electric shocks. In some areas of my legs there is a change of color where the skin is purple and the area is cold. I'm very concerned.

Dr. Patel:
Well I would consult with a vascular surgeon or a specialist to evaluate whether your leg discoloration is from a circulation issue or from the spine. You may want to consult with both a vascular and spine surgeon.




Christina:
In early 2011 I had multiple levels L2 L3 L4 L5 fused. S1 has no disc and the disc opening is covered with nerves. I still have pain in my lower back and recently I have been having headaches lasting as many as 5 day. Could this be caused by the spinal fusion? I also have pain in my butt cheek and my thigh area. My neck also has pain. Please give me insight on why this is happening

Dr. Patel:
You may be developing sacroiliac joint pain from the stress being created from your lumbar fusion which is extended to L4-5. You may want a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive then I would consider a therapeutic sacroiliac joint injection. If your symptoms fail to progress I would consider a minimally invasive sacroiliac joint fusion.




Subodh:
Would appreciate your advice on my condition. Around 6 months ago I felt some numbness on my left thigh without any other symptoms. This numbness always disappear within minutes after I changed my physical position while sleeping or resting, so I did not take it seriously. Within the last few weeks I’ve also started feeling pain at the back of my neck. It gets worse when I work on the computer or watch TV for long periods (2-3 hrs). I feel good when I have good sleep and no office work so I’m not sure if both of my symptoms are related or not? I am more concerned about the neck pain which sometimes spreads to my shoulder blades. Neck exercises help but I want to get rid of this pain.

Dr. Patel:
I don’t feel your leg numbness and neck pain are related. However, I would seek a consultation with a spine specialist to evaluate your neck symptoms. I have seen cases where patients have severe neck pain and then develop leg pain with the cervical spine creating both sets of symptoms.




Mitula:
I’ve been suffering from back pain off and on for the last 10 years. I’ve been regularly exercising and doing yoga. If a gap occurs in my exercise routine I get an attack of back pain again. Last 2 times have severe pain down my left leg. This time the pain is there for 3 to 4 months but very bad for the last 20 days. I started swimming and felt better but developed bad back pain so stopped. I’ve been off exercise for the last two months. Played tennis for 6 months also and tried jogging as well. I’m very concerned about my leg pain and have been taking homeopathic medication also.

Dr. Patel:
The leg pain could be radicular pain from a herniated disc or spinal stenosis. I would recommend an MRI of the lumbar spine without contrast with a consultation with a spine specialist to help correlate your leg pain symptoms with the findings seen on the MRI of the lumbar spine.




Anton:
I hurt my lower back in 2011, and was diagnosed by a Neurosurgeon with Bilateral Stress Fracture on my L5/S1 with spondylolisthesis grade 2 presently (was a grade 1 but progressed in a year’s time to grade 2). The Neurosurgeon is advising me to do a spine fusion. I work as a safari operator in Africa and my work is physically very demanding but since the condition started I have immense pain every day -- I get muscle spasms on a regular basis, my right leg goes numb when I sit for too long in a car, and I can’t control my urine very well. I just want your view on whether it is still safe to practice my profession working with international clients in the bush with dangerous animals everyday.

Dr. Patel:
If the issue is back pain and there is radiographic evidence of instability at L5-S1 from the spondylolithesis then you need the surgery, especially if the surgeon feels your bladder issues are being created from the spine. I feel you can do your job after the surgery once your spine surgeon provides you with medical clearance.




Miguel:
I had a fusion done in February of this year and had relief for a month. Then my pain came back when I was in therapy. I thought it was because of the therapy but after a while my right leg pain and lower back pain was horrible. I told my doctor how badly I was hurting and he ordered a myleogram. The results showed that my l4 l5 upper disc collapsed and he said these cases happen because when you get a fuse it puts pressure on the upper disc (or it can be lower) but in these cases the disc gives up from the fusion creating pressure. He said that this was unfortunately what had happened to me that I now need another fusion on l4 l5. I already have a lot of nerve pain from my previous injury but my adjuster won't pay for it cause she says it is not related to my injury and my doctor says yes, it is. Two doctors say it is related to my injury. Have you heard of this happening and how common is it? Please help me – I’m tired of dealing with the pain.

Dr. Patel:
Unfortunately, there is very little that can be done to reverse this process once you have a spinal fusion. Before getting the spinal fusion I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive for at least an 80 percent reduction of your concordant low back and leg symptoms with functional activity I would recommend a therapeutic injection. If your symptoms fail to progress then I would recommend a minimally invasive sacroiliac joint fusion. However if the diagnostic sacroiliac joint injection is negative then I would recommend the spinal fusion.




Nayef:
Is it possible to use the C02 techniques without an operation? My MRI showed multilevel degenerative changes more pronounced at L 5 - S1 with broad-based central disc protrusion at L4-5 with Rt foraminal narrowing. Bilateral foraminal narrowing Lt facet hypertrophy at L5- S1.

Dr. Patel:
If you have a right or left sided radicular pain from the broad-based central disc protrusion at L4-5, I would recommend a therapeutic selective nerve root injection under fluoroscopic guidance.




Diane:
When my SI joint goes out and rotates my pelvis I get all sorts of neurological issues, including terrible headaches, feeling exhausted, blurred vision, cognitive issues and feeling as though my entire spine is twisted like a dish towel. I have tried many things, including weekly physio, exercise, SI belt, SI stabilizing shorts, Pilates, but nothing has helped. Just turning in bed can cause my pelvis to rotate and my left SI joint to be very painful. I would like to know more about the surgeries and the outcomes.

Dr. Patel:
If you had a diagnostic sacroiliac joint injection under fluoroscopic guidance using only an anesthetic solution inside the joint and it was significantly positive then I would recommend a minimally invasive sacroiliac joint fusion.


August 2013

Souvik:
My father is suffering from lower back pain and his MRI report says L.S. spine suggests degenerative disc disease mainly affecting L4-L5 & L5-S1. Doctor recommended spine injection. Is this safe and risk free and can it cure the problem from its root.

Dr. Patel:
If your father has low back pain without severe pain from the buttock down the leg and the MRI of the lumbar spine demonstrates degenerative disc disease without foraminal or lateral recess stenosis then I don’t see the point of having an epidural steroid injection. Epidural steroid injections are effective for signs and symptoms consistent with lumbar radiculopathy.




Praveen:
I’m 22 years old and I’ve had back pain for 7 months. When I sit for 5 minutes the pain starts. I’m doing exercise also but it’s not going away. Please help me.

Dr. Patel:
If your pain hurts the most and quickest when sitting it is possible that the disc is causing your low back pain or the sacroiliac joint. If you are not having severe pain down the leg then I feel it’s more discogenic and the first thing would be to perform hamstring stretching in the supine position. I would also recommend a trial of lumbar traction and a McKenzie-style lumbar stabilization program.




Cathie:
Please explain the traditional SI joint fusion surgery. I was to have the iFuse with 3 titanium rods which was a better outcome than the traditional (bone graft), however insurance will no longer cover the newer way saying it is exploratory. I have heard the old way is a more painful and poses greater risks of infection. How do the two surgeries compare in your experience?

Dr. Patel:
You are correct. The traditional method is open and healing process is much longer than the minimally invasive method. It is very hard these days to find a surgeon that will perform the sacroiliac joint fusion open. Blood loss is much higher with the open and surgical time is much longer compared to the minimally invasive sacroiliac joint fusions when discussing with spine surgeons.




Alla:
I have a crawling feeling in my legs as if some things are walking there.

Dr. Patel:
Not sure. Could be early signs of a radiculopathy. Does it worsen with standing or walking or sitting? I would recommend seeing your general practitioner if it worsens.




Madhusudhanrao:
My father is 52 and he has been suffering with severe back pain the last 6 months. The problem is diffuse disc bulge is noted L5-S1 level causing mild thecal sac compression and impingement on bilateral lateral recesses. Please suggest the treatment for pain relief.

Dr. Patel:
If the low back pain is severe and it’s worse with standing and walking, and improved with sitting where the intensity of the pain is greatest in axial region and not in the lower limb region, I would recommend a diagnostic lumbar medial branch to ascertain whether the zygapophyseal joint at L5-S1 could be corroborative with your father’s painful low back symptoms with functional activities. If positive then I would recommend radiofrequency ablation of the medial branches to help relieve his low back pain.




David:
My SI Joint problem was found about 2 years ago. I have had 3 injections, each worked but became less effective, or wore off faster. I have been using the SI belt over a year as well. In the last 8 months I've had two Rhizotomys, the first provided huge relief almost instantly. After about 5 months pain started coming back. The second Rhizotomy didn't have the same effect, took a bit longer to recover from and didn't provide the relief like the first. My doctor wants to inject the joint with steroids and anti inflammatory. My question is when should I be pursuing a permanent fix? The surgeon I have seen referred me to pain management.

Dr. Patel:
At this point, if you had the diagnostic sacroiliac joint injection under x-ray to confirm the pain generator and then failed sacroiliac joint belt, therapeutic injections into the sacroiliac and rhizotomy, then I would recommend consultation with a spine surgeon to see if a minimally invasive sacroiliac joint fusion is the next step. I would hold off on anymore injections at this point.




Suzanne:
I've just been told I've got Spinal Sacral Canal Stenosis and I will deal with this but I am losing bladder control when I go to bed.

Dr. Patel:
Make sure to see a urologist to make sure this is not a problem in this department. You may need urodynamic studies to suggest if this a spinal issue or an extraspinal issue.




Wendy:
I am 31yrs old and I have a problem with the cartilage wearing off on my left and right hip, mostly left. My x-ray reports say that I have a facet joint problem and lordosis as well as avn on the L3-4 and L4-5 S1 in my lumbar spine area. I’m still waiting for my doc to see what’s gonna happen next. Could you please tell me what will be the next step to take forward with this medical condition?

Dr. Patel:
I would recommend seeing a spine specialist that specializes in interventional pain management. I would recommend calling the International Spinal Intervention Society (ISIS) and ask for a member of that organization within 50 miles of your address.




Jackson:
What treatment would I do to straighten my spine?

Dr. Patel:
Conservative options would include lumbar traction and improvement in hamstring flexibility.




Nicole:
I believe I have scoliosis and need help. I am 21 years old and I have been to several doctors about the pain that goes and comes. Moreover, they are saying it’s just muscle pain which I think it’s not.

Dr. Patel:
I would recommend seeing a spine specialist that specializes in interventional pain management. I would recommend calling the International Spinal Intervention Society (ISIS) and ask for a member of that organization within 50 miles of your address.




Marcus:
Hi, Doctor. I am currently deciding whether I am doing the i-Fuse operation or not. My problem is that I’m a professional soccer player in Europe (Netherlands) and I haven't heard about another athlete doing this before. Can you give me any information?

Dr. Patel:
As for more information on the surgery itself I would call SIBONE and they will assist in obtaining this information for you. You’re right: I haven’t heard of any professional athletes who had the procedure. However, its minimally invasive recovery time is a matter of weeks. If you are looking for alternative suggestions I would consider bipolar RFA of the lateral branches at S1, S2, and S3.


July 2013

David:
My wife has 3 disc herniations, fibromyalgia and stenosis in her back. What can she use to kill all this pain?

Dr. Patel:
Discuss these issues with an interventional pain management specialist board certified in pain medicine.




Pushpa:
My friend is suffering with Ankylosing Spondilytis for the last 7 to 8 yrs. His HLA B27 blood test resulted as positive status. He is suffering with lower back pain and left leg severely. He is taking treatment in homeopathy and naturopathy - spine exercises have been advised. Can you advise whether to go for homeopathy or naturopathy?

Dr. Patel:
It is possible that his low back and left leg pain could be related to sacroilitis. I would get an MRI of the left pelvis to see if there is inflammation of the sacroiliac joint and if positive I would recommend an intra-articular steroid injection into the sacroiliac joint on the left under fluoroscopic guidance.




Eva:
My knees are bone on bone both with no cartilage. I can't stand the pressure of walking full pressure on them so I use crutches and work in an electric wheelchair. I have owned my florist business for 30 years and before this happened 3 years ago, I stood on my feet at work all the time. I have been in severe pain since February and went to my orthopedic doctor. On June 18 he sent me for an MRI which revealed I had a herniated disc on s5-l1. The pain is excruciating. In 1989 I had a full hysterectomy due to complications from endometriosis and had to have many laser surgeries to remove adhesions. In the past few days my bowel movements have become rather weird as in not enough expelled and very small. My bowel area is in a growling, rolling mode. Should I take a good laxative to try and help? I have an appointment next Tuesday with a surgeon in Orlando, FL. I don't know if he works on the back area but I cannot live in this pain. Do you have suggestion for me which way to go or what to do? Thanks.

Dr. Patel:
My recommendation is to see a pain specialist that is board certified and is a member of the International Spine Intervention Society.




Ankita:
My mom is suffering from back pain and had surgery but again she is having the same problem. More than that, she has done many treatments but after15 days she felt that medicine is working. After that, the same problem started. What should be done for her?

Dr. Patel:
What type of surgery did she have?



Neenu:
I have severe lower left back pain from morning onwards and now it is radiating to my abdomen? What’s the cause for this?

Dr. Patel:
Structure along the lumbar spine could cause this pain. Lumbar facet joint, the disc, and muscle can all cause this referred painful phenomenon. I would consult with a spine specialist preferably someone who is a member of the International Spinal Intervention Society.




Suzanne:
I had a chiropractic adjustment done nearly four years ago. It caused immediate pain in the full length of my left sacroiliac joint, it never lessens. I saw and had adjustments from at least seven other chiropractors, all of which made it worse. I am so done with the pain, do you have any idea what it is, and what can be done, besides surgery?

Dr. Patel:
Steroid injection into the sacroiliac joint under fluoroscopy, sacroiliac joint belt and minimally invasive sacroiliac joint fusion are three options.




Abdun Nazar:
I experience pain when I sit. I get pain in my butt, hip area and down my right leg on the back muscles and I can only sit for a few minutes at a time. I saw 3 doctors and they advised me not to sit continuously more than 50 minutes and said to follow up some particular exercises for back and stomach. Can you please guide me in this subject.

Dr. Patel:
Differential diagnosis would include an S1 radiculopathy secondary to herniated disc to the left at L5-S1, sacroiliac joint pain syndrome, and piriformis syndrome. If you have not had an MRI of the lumbar spine at this point consult with a spine specialist preferable someone who is a member of the International Spinal Intervention Society to see if one of these three diagnosis could fit with your painful symptoms.




Janice:
After misdiagnosis I have been told I have SIJ pain (chronic). I have had cortisone and pain management (didn't help). I have been told to do lumbar traction (mechanical) and wonder if it is the right thing? I have also seen IFuse Implant system - My symptoms are spot on and due to an L5/S1 disc degeneration this was thought to be the problem before. Am very interested in having the procedure. Is there someone in Chiang Mai or only Bangkok? Should I stop physio or continue (traction and ultrasound at present), also exercises found on the internet (none of which seem to help)?

Dr. Patel:
If you had a diagnostic sacroiliac joint injection under fluoroscopic guidance and it was positive for significant pain relief I would consider IFUSE product to help alleviate your sacroiliac joint mediated pain. However if the diagnostic injection is negative and a lumbar discogram reproduced your current set of symptoms then continue with lumbar traction and improve hamstring flexibility in the supine position.




Teri:
I recently had surgery on my L5 s1. The first week after surgery the pain going down my right leg was ten times worse that it was before I had surgery. Went to ER and they just gave me a shot of Dilaudid . That Monday I went back to the surgeon who said he saw no reason for me to be hurting so bad. I was cramping so bad all the time that I could not put my leg straight and was using a cane. He sent me home with morphine and I was already on Vicodin and Percocet . The middle of that week I was hurting so bad and crying that on July 1st he sent me to ER to get an MRI. It showed no more disc herniation or any movement but sciatic is 10x size it should be. I am also having problems with my bowels - I am waking up and have had an accident awake and sometimes it just leaks out and when it comes to urine I feel it but can barely make it. I still can’t sit on right side and still hurt very bad with cramping. Do I need a second opinion? Every time I try to talk to the doctor he over talks me and told me that my bowel and urine issue should have nothing to do with this. My hip and leg hurts so bad - still using cane and other hip is starting to now too.

Dr. Patel:
Consider a sciatic nerve block and/or an S1 selective nerve root block to help the lower limb pain.




Lim:
I had a fall 30 yrs ago and today I’ve the same complaints. I’ve got left buttocks pain and back pain on standing for too long.

Dr. Patel:
Could be a sacroiliac joint dysfunction induced from the fall. I would consider a rehab program and gentle manipulation of the sacroiliac joint to see if this helps to reduce the symptoms. If that helps but not enough, consider a cortisone injection into the sacroiliac joint under fluoroscopic guidance. If that does not help much, consider a diagnostic sacroiliac joint injection under fluoroscopic guidance using an anesthetic solution. If the pain reduces significantly within the first few hours then consider a minimally invasive sacroiliac fusion using the IFUSE product.




Anna:
I have severe pain in my lower back. When I sit or turn to the right side or left I have very sharp pain. This occurs about every 6 months.

Dr. Patel:
Could be a sacroiliac joint dysfunction intermittently. I would consider a rehab program and gentle manipulation of the sacroiliac joint to see if this helps to reduce the symptoms. If that helps but not enough, consider a cortisone injection into the sacroiliac joint under fluoroscopic guidance. If that does not help much, consider a diagnostic sacroiliac joint injection under fluoroscopic guidance using an anesthetic solution. If the pain reduces significantly within the first few hours then consider a minimally invasive sacroiliac fusion using the IFUSE product.




Meena:
My father (age 77) is suffering from disc degenerative disease. He has been experiencing lower backache which sometimes moves from one side to the other. He has suffered a mild heartattack, a mild stroke and has hypertension for which he is on meds. He has osteoporosis as well. Are painkillers and physiotherapy the only solution to this?

Dr. Patel:
His low back pain could be emanating from the zygapophyseal joint of the lumbar spine causing a syndrome called lumbar facetogenic pain syndrome. I would recommend an appointment with an interventional pain specialist. They would recommend a diagnostic lumbar medial branch block at the levels where they feel his pain could be emanating from. If this diagnostic injection demonstrates a significant reduction of his pain with functional activity within the first few hours then I would recommend radiofrequency ablation at those levels to help alleviate his low back pain.




Mir:
For the last 7 hours I have been experiencing pain in upper back, under the neck between the shoulder scapula and feel lots of pain in vertebra while moving any way. I am 22.

Dr. Patel:
Could be a myofascial pain disorder. I would recommend physical therapy, massage therapy and gentle manipulation of the painful areas.




Gordon:
I am having very bad pain in my lower back. Some weeks it comes from left of centre below L level and then another week from the right of centre below L level but never at both sides at the same time. Is that indicative of S1? The MRI scan I had recently does show wear at L4 and L5. As I write this I also have terrible sciatica type pain running down my right leg to my calf. How do I determine what is causing the problem?

Dr. Patel:
So if the leg pain is moving down the side of your leg then it’s possible that the L5 nerve root is irritated from the wear and tear your specialists see at L4-5. I would recommend an electrodiagnostic evaluation to see what the severity of the nerve root injury is only if there are MRI findings to suggest your leg pain could be secondary to a lumbar radiculopathy. If positive then a potential treatment could be a therapeutic selective nerve root injection to help alleviate your right-sided leg pain.




Karen:
I have l5 s1 nerve pain. Had microdisecomy /rissiolzlis in 2012 but still in pain. Complications after surgery included a CFS leak.

Dr. Patel:
I would recommend a repeat MRI of the lumbar spine with and without contrast. If there is evidence of perineural fibrosis around the L5 and/or S1 nerve root with no new herniation a spinal stimulator trial would be a good option. If positive then consider permanent placement to address your leg pain.


June 2013

Dhanesh:
I am 41 yr old male & having lower back problems from 2006. Last year and again last week I had a tremendous pain in my right side lower back and my body tilted to the left side. I couldn't sit or walk properly and had to take complete bed rest using pain killers and ice packs. I went to a chiropractor who says there is a problem with my pelvis, but the physiotherapist says something different. What exactly has caused my lower body to tilt & what are the precautions I have to take? Are there any exercises I can do to make it straight?

Dr. Patel:
It is possible that the sacroiliac joint in out of alignment and needs a simple adjustment. However the L5-S1 level could have abnormal finding seen on an MRI that could be corroborative with your systems. My only thought for now is to improve your hamstring flexibility while lying on your back. Improving pelvic flexibility could help to restore your alignment. However if it is still painful even after right-sided tilt improved then a diagnostic sacroiliac joint injection under x-ray guidance would be the next step. If positive for a significant reduction of your right sided low back symptoms then I would consider cortisone into the sacroiliac joint. If you don’t see much improvement then consider a minimally invasive sacroiliac joint fusion.




Kasey:
I am 35 years old with a T2-L2 fusion from scoliosis at age 11. 2 years ago I dislocated my SI joint in an accident and have not recovered since then. I take daily NSAIDs and visit a local chiropractor. I have tried injections, belts, and PT in the past but the symptoms (right buttock pain radiating down to knee) comes back. I want to be active but the pain limits me greatly (I am also a mom to 2 young children). I refuse to take narcotics and muscle relaxers as I feel these mask the symptoms and I am unable to work then. The doctors have suggested a pain pump (but once again, I would not be able to work). My questions are: (1) I noticed patients that had the iFuse surgery are older. Would I be a candidate considering the scoliosis and age? Question (2) - How much does the fusion limit mobility? Would I be able to run, play soccer, workout, etc? Question (3) - What is the average recovery time? I am a nurse and my work requires me to lift patients.

Dr. Patel:
Q1: Young patients can receive a minimally invasive sacroiliac joint fusion using the IFuse product. The question is whether the sacroiliac joint is corroborative with your symptoms. I would recommend an anesthetic block under x-ray to see if there is a significant reduction of your painful symptoms. If positive then I would consider a minimally invasive sacroiliac joint fusion using the IFuse product. Q2: It does limit sacroiliac joint mobility but the goal is to reduce pain along the sacroiliac joint. With appropriate stretching and maintenance of flexibility of the hamstring muscles and other muscle that support the sacroiliac joint you should be able to perform normal activities. Q3:You are non-weightbearing for 3 to 6 weeks. You may be able to return back to work thereafter once you have completed a few weeks of physical therapy.




Zoya:
I have constant right leg pain, and knee pain after walking. Every joint of my right leg is painful.

Dr. Patel:
I would seek an interventional spine specialist for a consultation. Contact International Spine Intervention Society and see if there is a specialist in your area.




Rita:
I have been having pain in my lower back since last month and I took Lofnac but it’s not helping and it makes me feel as if am sick. I am uncomfortable -what should I do?

Dr. Patel:
I would seek an interventional spine specialist for a consultation. Contact International Spine Intervention Society and see if there is a specialist in your area.




Nadine:
My spine is fused from T2-S1. My pain started in 1994 and I saw a chiropractor, then an MD and then a spine surgeon in Minneapolis. It started with the lumbar surgery in 2000 and then T2-S1 in 2007. The surgeries helped for a year or so and then some screws would loosen up and then to fix that. There are no more options from my surgeon. My pain started out with SI pain in 1994. I have had them injected several times and with relief for a period of time. Since I had the total spinal surgery, I have constant pain and it is in my buttocks (right now just the L) and dull pain in my legs. I cannot walk more than 75 feet, cannot stand for more than a minute. I sit in a lumbar recliner which works most times as well as laying down. I am on 4 hydrocodone pain med (10 mg/325) a day. I want to go down in pain meds and be able to walk again. I use a wheelchair when I go places but for the most part I am isolated at home. I want out of pain for once in my adult life. I am 65 yrs old. I have to go to PT 2 times a week to help relieve some pain. I do respond to micro current that PT provides me.

Dr. Patel:
I would have a diagnostic sacroiliac joint injection with anesthetic only under x-ray guidance to help determine if your current set of symptoms is emanating from the sacroiliac joint. You would know if the diagnostic injection is positive if the reduction is significant with functional activities. At that point I would consider a minimally invasive sacroiliac joint fusion using the IFuse product.




Ed:
I had an MRI of the spine and they said it did not require surgery. My pain is at a 10 and I have a hard time walking. They gave me steroid shots in both hips and I must say after that shot in the left hip I felt like I was 18 again. It was short lived though: 3 days and was back in pain and have a hard time walking. They also injected l4 l5 but there was only small progress. No one takes the si joint seriously. I am looking for a Dr to rule it out.

Dr. Patel:
I would call the International Spine Intervention Society and ask for an interventional spine specialist in your area. I would recommend the specialist to perform a diagnostic sacroiliac joint injection under x-ray guidance using just an anesthetic and not cortisone. If your symptoms are significantly reduced for the duration of the anesthetic then I would consider a minimally invasive sacroiliac joint fusion.




Sheila:
I had surgery in 2009 for sciatica. My nerve was severely damaged and had to be put back together. Now, I am having all the same systems that I had back in 2009. My left side has always been the problem, but now I am starting to feel these symptoms on my right side at times. Please advise and thank you in advance.

Dr. Patel:
I would call the International Spine Intervention Society and ask for an interventional spine specialist in your area. I would recommend the specialist to perform a diagnostic sacroiliac joint injection under x-ray guidance using just an anesthetic and not cortisone. If your symptoms are significantly reduced for the duration of the anesthetic then I would consider a minimally invasive sacroiliac joint fusion. If the diagnostic sacroiliac injection is negative I would recommend an MRI of the lumbar spine with and without contrast to ascertain if there is scar tissue around the nerve root emanating from the lumbar spine that could be corroborative with your current set of symptoms.




Jo Anne:
What is the true recovery time to full weight bearing time?

Dr. Patel:
Typically 6 weeks.




Natasha:
I have always had back pain but now after my 6th child was born my lower back is in severe pain all the time. I must use a heating pad for slight comfort to help me sleep. The pain goes from the lower mid back area to my hips. Please help me figure out what it could be as all my doctor tells me is to take pills that don't help me.

Dr. Patel:
I would call the International Spine Intervention Society and ask for an interventional spine specialist in your area. I would recommend the specialist perform a diagnostic sacroiliac joint injection under x-ray guidance using just an anesthetic and not cortisone. If your symptoms are significantly reduced for the duration of the anesthetic then I would consider a physical therapy program toward stretching and strengthening the muscles that support the sacroiliac joint. If you fail to progress with this intervention, consider manual medicine and possibly a cortisone injection into the sacroiliac joint. If you fail to progress, then I would consider a minimally invasive sacroiliac joint fusion. If the diagnostic sacroiliac joint injection is negative I would consider having an MRI of the lumbar spine to ascertain if a degenerative disc does exists along the lumbar spine that could be corroborative with your painful symptoms.




Ram:
I suffered disc herniation at l5-s1. I am 24 and Its been 4 weeks since it happened while exercising (bending back). I want to know whether I can be normal again with out worry. I play cricket (bowler) - can I bowl again? What kind of exercises should I do to help the healing process? What is the end result of the healing process -- whether the muscle develops around the nucleus?

Dr. Patel:
If you have a symptomatic herniated disc at L5-S1 you would have severe posterior buttock thigh and calf pain worse with sitting depending on the size and direction of the herniation. If these are the symptoms you are experiencing I would recommend a therapeutic S1 transforaminal epidural injection 1 to 2 times in conjunction with an extension biased stabilization program. If you fail to progress I would recommend a decompressive laminectomy and microdiscectomy at L5-S1.




Mohammad Reza:
One morning last year I had severe vertigo with vomiting. I called various doctors specializing in brain and ear and after a complete medical examination and MRI and ear medical tests fortunately all results were acceptable. BUT that vertigo came back again. My question is: can the disc at level C5-C6 (neck) and L4-L5 (back) be the reason for the vertigo? I have had this problem in neck and back for a long time. When I have vertigo I have no dynamic equilibrium in walking that after some days calms gradually. Please inform me in this matter.

Dr. Patel:
Good question. If you notice severe neck pain when you have the vertigo-like symptoms then yes the degenerative disc could be concordant with your neck and vertigo-like symptoms. However if the neck pain and vertigo are not directly correlated with one another then it is most likely benign positional vertigo and you will need to perform a vestibular physical therapy program to improve these symptoms.




Dane:
I am 60 years old. 3 1/2 years ago I was in a motorcycle accident that shattered my pubic bones and caused total dislocation of the left SI joint. It also caused the shattered end of the left pelvis to come through the skin on my left leg just about where the leg joins the crotch area. I was fitted with an SI screw to stabilize the left SI joint. All other injuries were left to heal on their own. I was in excellent physical condition before the accident and about 8 months ago I started doing Yoga. Yoga has helped me tremendously, much more than the PT I did after my hospital stay. It has gone a long way towards breaking up my scar tissue and making me feel 40 and getting me active again. I assume the SI screw is meant to fuse the SI joint together. My original surgeon never explained anything to me during our 3 short conversations together. My question is: Will yoga have any harmful effects on the SI screw and that joint?

Dr. Patel:
No. Yoga helps to maintain good to excellent muscle tone especially when directed towards the muscles that help to support the sacroiliac joint. You are doing the right thing.




Ralph:
I have been having lower back pain for almost a month now. Recently, the pain has gotten worse and started radiating into my left abdomen, especially in the flank area, and towards the mid-back. I already consulted with a local physician and had undergone a test for any kidney problems. But, the test turned out negative. I am really anxious about my situation. Any response to give light to my current situation would be greatly appreciated. Thank you very much.

Dr. Patel:
Based on the fact you have low back for approximately 4 weeks it is still unclear what is causing it at this point. I would try a few different physical therapy regimens to see if the symptoms will dissipate. You could try a biased stabilization program, lumbar traction and/or aquatic therapy. If you fail to progress consider an MRI of the lumbar spine. If the MRI is normal then this is myofascial pain syndrome and yoga may be a good adjunctive option to help with your symptoms.


May 2013

Andrew:
I am 36 years old and have been a smoker for almost 20 years. I have been having persistent waist (lower back) pain for more than 3 years. I have stopped smoking recently after a series of medications from both herbal and medical Doctors, but my waist pain still persists. What can I do?

Dr. Patel:
I would see an interventional spine specialist to further evaluate your symptoms. Does your pain hurt more when standing or walking versus sitting? Some structures that cause pain along the waistline area include the sacroiliac joint and facet joint at L5-S1. The specialists can perform diagnostic injections to further validate whether the symptoms are emanating from these potential structures based on percent relief with functional movements for the duration of the anesthetic. Call the International Spine Intervention Society for a physician in your area if available.




Kathy:
physical therapy when my si joint was injured in 2007. I have been through many DO remedies to no avail. Now my L3-4 disc has herniated. Could this be partly because my Si joint is out and my weakened L5S1 disk area?

Dr. Patel:
It is possible that the pain could be emanating from the facet joint at L5-S1 if you have not had any fusions at L5-S1. If prior to the three operations for a herniated disc at L5-S1 you had severe pain down the back of the leg it is possible that the weakened S1 nerve root from the disc protrusions in the past made the muscles supporting the sacroiliac joint weakened thus providing an sacroiliac joint dysfunction. This dysfunction will cause a herniated disc at L3-4. If you don’t have severe pain radiating down the anterior thigh and shin then most likely the herniated disc at L3-4 if central or posterior lateral is in remission and not causing symptoms. If strengthening of the lower limb muscles does not help with manual medicine then have an interventional pain specialist perform a diagnostic sacroiliac joint injection under x-ray to evaluate whether your current set of symptoms does reduce by at least 75 to 80 percent with function activities for the duration of the anesthetic. If positive and you have not had at least 6 weeks of consistent relief with therapeutic sacroiliac joint injections then consider minimally invasive sacroiliac fusion using the IFUSE Product.




Sarah:
Two months ago I had L4 and L5 fusion with Pedicle screws. 6 wks ago I started getting tailbone pain. I can't sit more than 10 minutes. Sometimes its unbearable. I asked my Neuro-surgeon that performed the surgery what it was. He said he didn't know, and had never heard of anyone else having this type of pain. I was shocked since I have read so many people get tailbone pain. He send me to PT and wants an MRI to ensure there is not any damage below the surgery area. Can you please give me some insight on this? I can't work, and don't know how long this pain will go on. I also get nerve pain on my left leg. Doctor said he had corrected the pinched nerve I had on my left side. I still have some nerve pain and weakness on that left leg, which caused me to twist my ankle. My left foot and ankle hurt a lot. Any advice? Thanks so much

Dr. Patel:
It is possible that the fusion at L4-5 could be placing stress across the facet joint at L5-S1 or the sacroiliac joint. If strengthening the lower limb muscles and improving hamstring flexibility while supine does not help with manual medicine then have an interventional pain specialist perform a diagnostic sacroiliac joint injection under x-ray guidance to evaluate whether your current set of symptoms does reduce by at least 75 to 80 percent with function activities for the duration of the anesthetic. If positive and you have not had at least 6 weeks of consistent relief with therapeutic sacroiliac joint injections then consider minimally invasive sacroiliac fusion using the IFUSE Product.




Varsha:
What do “posterior annular tear at C4_C5” and “bilateral fibrous rudimentary cervical ribs” mean? What should be done?

Dr. Patel:
This just means that the disc is dehydrated because it has less nuclear material which contain chemicals that imbibe water into the disc. As a result, the disc height gets smaller and places more stress across the annulus, becoming more susceptible to tears.




Hari:
My MRI reports broad-based paracentral herniation at L2-3 with partial extension into both neural foramina causing mild to moderate impression on thecal sac and adjacent nerve roots. Please let me know what this means in simple terms.

Dr. Patel:
If you have moderate to severe pain along the posterior buttock and medial thigh worse with sitting and/or standing/walking then it is possible that the L2 or L3 nerve roots could be corroborative with the MRI findings. Remember the MRI does not detect pain. What needs to happen is linking your current symptoms with a structural finding.




Elizabeth:
I have lower back pains that make it very hard to walk. The pain goes through my left leg, and the bottoms of my feet hurt. It is also very hard to bend over and when I do bend I can't get back up. I am very tired of being in bed. I do work at a school as a building foreman so I do a lot of walking on hard tile floor.

Dr. Patel:
It is possible that the S1 nerve root from a herniated disc could be the source of your painful symptoms. However it could also be emanating from the sacroiliac joint. If they persist see an interventional pain specialist that can evaluate your symptoms.




Robert:
I have been going to a chiropractor and there is no relief. The pain is at the base of my spine between the hips. On occasion there may be sharp pain to either hip. I have pain when bending over in the morning and cannot walk or stand for lengths of time. My pain is reduced as the day progresses and I have minimal pain when sitting. Are these symptoms consistent with sacroiliatis?

Dr. Patel:
They could be consistent with sacroiliac joint pain. Did your specialist perform sacroiliac joint tests that recreated your typical pain? Did you have a diagnostic sacroiliac joint injection under x-ray guidance? If not, I would recommend seeing an interventional spine specialist that can further evaluate your symptoms. Call the International Spine Intervention Society and ask for a specialist close to your area if available.




Catherine:
I am a Nursing Aide in a nursing home and I got hurt lifting a 450lb patient. I can’t sit for long periods, plus walking is an issue and sleeping is a problem.. I have an SI joint problem and I have been going to swim therapy and physical therapy. I asked my workmen’s comp doctor about the ifuse surgery and he said that it does not work. He suggested an SI injection and this will be my second injection. Is he right? Will my back be ok to do lifting again or should I change jobs in the future?

Dr. Patel:
Did your specialist perform sacroiliac joint tests that recreated your typical pain? Did you have a diagnostic sacroiliac joint injection under x-ray guidance using only anesthetic not steroid? If not I would recommend seeing an interventional spine specialist that can further evaluate your symptoms. Call the International Spine Intervention Society and ask for a specialist close to your area if available. If the diagnostic sacroiliac injection under x-ray guidance demonstrates significant pain relief for the duration of the anesthetic then a minimally invasive sacroiliac joint fusion using the IFUSE product is indicated. I would hold off on vocational rehab until you have the confidence that an accurate diagnosis has been made.




Vanessa:
I am a Lab Tech, 35 and female. About 3 months ago I lifted a 40 kg bag of iron ore sample and hurt my upper back on the left. I had only Physio and 2 months later I asked to have some investigation done because I am still in pain that goes to my arm and shoulder, inside my left breast and numb left hand with lots of spasms. They have not found anything. They did an MRI and everything looks normal but on T10/11 it showed a minor anterior osteophytic lipping. Is it from my injury?

Dr. Patel:
It could be a rib dysfunction. See an osteopathic physician and see if manual medicine to this area helps. However it could be emanating from the C7 or C6 nerve root. Did you have an electrodiagnostic evaluation of the left upper extremity? Did you have an MRI of the cervical spine? If the electrodiagnostic evaluation and MRI of the cervical spine is normal then see an osteopathic physician that specializes in OMT.




Jen:
I had SI joint jab 11 weeks ago and I’m due to go back to the doc at pain management this week. I’m still in a lot of pain. I have stinging in the lower left and buttock pain and the pain level is about a 6 out of 10. I’m on Tramodol since February but they only take the edge off. I can’t sleep on my right side. Any idea what I could tell the doc? I just want 1 day without pain.

Dr. Patel:
Did your specialist perform sacroiliac joint tests that recreated your typical pain? Did you have a diagnostic sacroiliac joint injection under x-ray guidance? If the diagnostic sacroiliac joint injection did demonstrate a significant reduction of your typical symptoms for the duration of the anesthetic then consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Reema:
My husband's MRI report says three things:
1. straightening of the lumber spine with loss of normal lumbar lordosis
2. degeneration of L4-L5 and L5-S1 intervertebral discs
3. mild diffuse bulge of L4-L5 and L5-S1 intervertebral discs intending bilateral traversing L5 and S1 nerve roots respectively
Please explain and advise.

Dr. Patel:
You will need to see an interventional spine specialist to evaluate your symptoms. Some of these findings may be in remission and some in relapse mode. Remember MRI does not detect pain. The difficult task is to correlate your symptoms with a structural finding if possible.




James:
I’m 21 years old and I fell down the stairs 5-6 years ago. I had severe pain in my lower pain and was unable to sit properly. The pain left and then after 2 years came back, when I had severe pain in my hip and my leg. I was unable to walk standing straight. I went for physiotherapy sessions and did exercise and the problem went away. But now the problem has come back again I feel so much pain in my leg and I’m unable to walk properly. What should I do?

Dr. Patel:
Did your specialist perform sacroiliac joint tests that recreated your typical pain? Did you have a diagnostic sacroiliac joint injection under x-ray guidance? If not I would recommend seeing an interventional spine specialist that can further evaluate your symptoms. Call the International Spine Intervention Society and ask for a specialist close to your area if available. You may need just a therapeutic sacroiliac joint injection under x-ray to calm down the symptoms. Falls are one of the most common antecedent events for developing sacroiliac joint dysfunction.




Amrit:
I have got a lot of neck pain and it radiates to my arms, too. What should I do? I have muscle pain and my job requires me to stay all day on my PC.

Dr. Patel:
This is not enough information. You need to call the International Spine Intervention Society and ask for a specialist in your area. Based on the history, physical exam and diagnostic studies a differential diagnosis can be established and then treatment options.




Nilesh:
My question is how to stop the vibrating in my body and in my hand.

Dr. Patel:
The vibrating symptoms in the hand could be carpal tunnel syndrome. You may need an electrodiagnostic evaluation. If negative and your neurologist does not know what is causing this set of symptoms you need to call the International Spine Intervention Society and ask for a specialist in your area. Based on the history, physical exam and diagnostic studies a differential diagnosis can be established and then treatment options.




Shilpa:
I am having severe pain in my right arm. I cannot pick up a mug full of water and cannot even bend it. Pain is coming up to the shoulders and down near the wrist. Please suggest what you think this is and kind of doctor I should see.

Dr. Patel:
You need to call the International Spine Intervention Society and ask for a interventional spine specialist in your area. Based on the history, physical exam and diagnostic studies a differential diagnosis can be established and then treatment options.




Phyllis:
Is there any type of drainage at the end of the tail bone that the drainage site can get inflamed?

Dr. Patel:
If you have drainage emanating from your tail bone this is a problem. See you family physician for further evaluation.




Cassi:
I have a horrible stabbing pain in the middle of my back and I've tried massage but it doesn't help. I am only sixteen and I shouldn’t have pain like this. Could you tell me what it could be?

Dr. Patel:
It could be the disc along the thoracic spine, stress fracture, myofascial pain or rib dysfunction. You need to call the International Spine Intervention Society and ask for a specialist in your area. Based on the history, physical exam and diagnostic studies a differential diagnosis can be established and then potential treatment options from least aggressive to most aggressive.





April 2013

Nannette:
I have been suffering with SI joint dysfunction for several years and am practically immobile. I am living on Percocet 10's and am in constant severe pain. I have a doctor that is willing to perform surgery but not the iFuse and I am not comfortable with him. He says there is only a 75% guarantee for this type of surgery. I am a 51 year old female in fairly good health but have put on forty pounds due to the immobility and medication. Is the rate of success better with the iFuse? And is there a doctor in the Indianapolis area trained in the iFuse? I have also been turned down by my insurance because they say I am a pre-existing condition so we are fighting that battle as well. Anthem then was going to pick us up and at the last minute they said they were denying us because I was taking narcotics!! Good grief! We were overseas missionaries with international insurance and had to come home because of my SI problems so the insurance issue has been a real mess. Sorry to ramble. I need help :)

Dr. Patel:
Did you have a diagnostic sacroiliac joint injection using just anesthetic and not cortisone? If you have and it did demonstrate at least a significant (75 percent) reduction of your typical painful symptoms and/or your physical exam demonstrated at least 3 positive provocative sacroiliac joint maneuvers increasing pain in your typical region, the IFUSE is an excellent next step. If the issue is with narcotics then simply get yourself on a weaning program where you decrease the pills by 1 per week until discontinued, then have the surgery. If you are looking for a surgeon that performs IFUSE then call the helpline number on SIBONE website. They should be able to assist you with a surgeon that has been successfully trained. Take care.




Patricia:
I cannot sit on anything soft, even a small amount of foam as used on Backfriend sets off my pain. It dates back to pregnancy 30 yrs ago. Right side is worse. A belt helps. Can I be helped? Thank you.

Dr. Patel:
Establishing a diagnosis first is the most important thing. Once this has been established then a proper course of treatment options can be laid out for you from most aggressive to least aggressive. If you need to find someone, contact International Spine Intervention Society and ask for someone in your area. Yes, your symptoms can be helped once a proper diagnosis has been made.




Heather:
Could this SI joint pain cause the pins and needles feeling in both my legs and feet?

Dr. Patel:
Yes SIJ pain can cause pain from the buttock down towards the feet. The quality can range from dull achy to pins and needles to shooting pain.




Kuldip:
In my latest MRI cervical, - done last year - pain along neck, arms, knees and arms, ankles, pain travels to head, feeling fatigued/weak, hard to move neck. Impression - Degenerative changes at C5-6, C6-7, resulting in moderate to severe foraminal stenosis on the left at C5-6, and on the right at C6-7, Moderate foraminal stenosis noted on the right at C5-6, moderate to severe foraminal stenosis noted on the right C6-7, no significant spinal stenosis is seen. There is mild reversal of normal cervical lordosis which may be positional or may reflect muscle spasm. Mild intervertebral disc space narrowing noted at C5-6 and C6.

Dr. Patel:
Do you have more pain along the arms or the neck? If it is the arm, how does the pain travel (shoulder blade, posterior arm and forearm?) Key point is to develop a method to link your active symptoms with structural pathology.




Mike:
Taking pain killers daily. Have started physiotherapy – will tension and some gel massage with pins be helpful? I am 54, diabetic with hypertension and some more belly weight. What do you suggest with my present conditions?

Dr. Patel:
What present condition did your physician tell you causing your painful symptoms?




Cindy:
Will a tanning bed effect my stimulator?

Dr. Patel:
I would defer this question to the manufacturer. Call your representative.




Pranathi:
I am suffering from low back pain on the left side for the last 4 years and have consulted many specialists. All my MRI reports were negative and bonescan shows hot spot near the left SIJ (near the ligaments on the lower side of SIJ). I also had undergone Cortisone injections to SIJ twice in the span of 1 year.

After the various MRIs, a sports physician and a Rheumatologist suspect that the problem could be SIJ and they have prescribed the Physio to strengthen my core muscles. I am undergoing physio and exercise physio for the last 15 months. In spite of following the conservative treatment, my condition has not improved and moreover it has become worse.

My current specialist. who is a Rheumatologist with Physio as his secondary specialty, believes that the pathology shown in the bonescan should not give me such pain levels and he does not have an explanation for the severity of pain levels. He also reckons surgery might not help my situation as he recons the joint mobility does not appear to be very much based on the bonescan and MRI reports. He also says that he does not see any ligament laxity at my SIJ. Not sure if this can be observed using MRI and bonescan. He does not have any more answers and at the same time believes that no other treatment option will help my situation except the conservative treatment.

At the moment the LBP affects my lifestyle significantly as I cannot walk more than 12 minutes, stand continuously for more than 5 minutes, and cannot do any of my household chores like cooking, etc. Even if I bend my head to read a book, etc then I get pain in my lower back. Pain sometime comes in the butt area or just near the dimple above the butt, or the leg feels very heavy or constant ache in the leg (front thigh to toes). I also experience that my hip joint goes into spasm (into a locked state) and I cannot even move an inch as if my leg has been stuck. After some time it gets released on its own if I lie down or sit. I get temporary relief when I do my exercises at home but the pain comes back again and overall on the whole I do not see a positive trend.

I am reaching out to you with few questions wondering if you could help answer considering your experience in dealing with SIJ:

1) Could there be any other reasons that might cause pain at SIJ region but SIJ may not be the cause of the pain? Please note that I get my pain in the butt area and also the pain goes to my toes (similar to sciatic pain). I feel pain in the thigh region at the front. When the doctor does his physical tests (when applying pressure to SIJ), then I do get pain in the region). RESPONSE: Yes. Radicular pain and piriformis syndrome are causes that mimic sacroiliac joint pain: if the MRI of the lumbar spine is normal and sacroiliac joint provocative tests increase pain in your typical painful region, then it is reasonable to assume that either the joint or the ligaments is the source of the pain. The tests I use are FABRE, COMPRESSION, DISTRACTION, GAENSLEN, PELVIC THIGH THRUST. 2) If my pain is due to SIJ, then why am I not a candidate for surgery? I thought if none of the conservative treatments works then surgery is the last option. What are the key criteria to consider for surgery where the success rate of the surgery is high? Please note when I had my first SIJ injection, I did not feel pain (0 level) for 3 days on left side where the injection was administered but I felt pain on the right side during those 3 days. Second time, I did not feel any reduction in pain levels. I did not feel pain for maximum an hour maybe but I did not have pain just prior to the injection.

RESPONSE: You may be a candidate. If you had an anesthetic block into the sacroiliac joint without cortisone and this injection demonstrated significant relief of your painful symptoms then I would consider a minimally invasive sacroiliac fusion using the IFUSE product.

3) Are there any other diagnostic tests to rule out other potential problems? Blood tests were done to check my inflammatory diseases and the blood tests all came back negative.

RESPONSE: Rheumatologic workup, HLA-B27.

4) I live in Australia and I am not sure who would be the best specialist to have another look at my problem. I have already consulted an Orthopaedic surgeon, Rheumatologist, Sports Physician, Rheumatologist with Physio expertise and Acupuncturist. The sports physician and the second rheumatologist diagnosed the problem as SIJ but treatment options were always Physio.

RESPONSE: Nikoli Bogduk, MD, Founding member of International Spine Intervention Society

5) Is it common to have referred pain to toes similar to Sciatica as a result of SIJD?

RESPONSE: YES: Referral studies have been performed that validate that pain can be referred into the feet. The quality of the referred pain can be similar to radicular pain.

6) Why do some people not respond to conservative treatment? Is it because their SIJ degeneration is severe or their ligaments are worse affected?

RESPONSE: No, everyone is different. Using age, chronicity of injury, degree of sacroiliac joint degeneration does not validate which treatment is best. Simply go from least aggressive option to most aggressive.




Manauti:
I have a hypermobile SI joint and a misaligned pelvis. Is prolotherapy safe? Can it cause a problem if done on the back, like nerve damage?

Dr. Patel:
Prolotherapy can be safe in the hands of an experienced physician. Yes, nerve damage can occur if performed improperly.




Jenny:
I had cortisone in left SI joint 6 weeks ago, as pain was real bad. Now I still have pain and left leg feels numb and I have problems climbing a lot of stairs.

Dr. Patel:
If the treatment is not helping and you’re concerned that the sacroiliac joint is the source of the painful symptoms, have a diagnostic sacroiliac joint injection without cortisone and just anesthetic. If this reduces your pain by at least 75 to 80 percent for the duration of the anesthetic then continue with the more aggressive treatment options for sacroiliac joint pain syndrome.




Lisa:
I have pain on my right leg. MRI results shows minor problem on my back, and my doctor thought I have an SI joint problem. Then he gave me an injection and the pain stopped for two days and he sent me to physical therapy for three months. But the pain I have doesn't go away – I‘ve been like this for eight years. I am still doing some exercise and taking ibuprofen to reduce my pain. My question is why my doctor keeps changing his mind and giving different meds. I am confused with my problem. What do you advise?

Dr. Patel:
If the treatment is not helping and you’re concerned if the sacroiliac joint is the source of the painful symptoms, have a diagnostic sacroiliac joint injection without cortisone and just anesthetic. If this reduces your pain by at least 75 to 80 percent for the duration of the anesthetic then continue with the more aggressive treatment options for sacroiliac joint pain syndrome.




Suhail:
My younger brother had a horrible road accident in September 2012. He injured his left leg fracturing thigh bone, knee, and another fracture just above his toe. He underwent 8 hours of successful surgery where they inserted two rods - one in thigh, another in leg. The most amazing thing is that he started walking without any support after 20 days. For our family, friends and even for the doctor this was an amazing recovery, but since then he is suffering from foot drop. He is using AFO to walk. Whenever we consult with the doctor he tells us to give more time to it. There is small recovery in his foot and he can move his fingers downwards. Being a good sportsman, he even tries to runs sometimes. I am really worried about his condition. He is out of his College team for 6 months and no idea how long before he can play again. Should I schedule a nerve test for my brother or should I just wait as the doctor advised? Also, if he has nerve surgery, how long would that surgery be? What is the chance of a full recovery?

Dr. Patel:
I would get an electrodiagnostic evaluation of the leg and see if the nerve damage is from the L4 or L5 nerve root versus the deep peroneal nerve.




Sujith:
I have a disc protrusion problem: small posterocentral disc protrusion at l4-5 and l5-s1 levels indenting the thecal sac. I would like to know the treatment available, precautions to be taken, and what I need to do to overcome this problem permanently.

Dr. Patel:
If you don’t have pain from the buttock down the leg then start performing hamstring stretches while lying on your back only. This will help reduce back pain when you lean forward to reach for an object. Lumbar tractions can be useful for back flareups. Avoid twisting while lifting something.




Mike:
I have a history of cervical disc failure/fusion, but over the last week my lower back has begun to hurt to the point I am bedridden. I take a variety of very strong narcotics permanently and it's enough to override even them.

Dr. Patel:
I would call the International Spine Intervention Society and see if there are specialists in your area that can workup your acute low back pain. Try a prednisone taper if you haven’t at this point.




Abdulkadir:
I am suffering from neck stiffness for the past two years. l have seen many Doctors but still no cure. Please advise me.

Dr. Patel:
I would call the International Spine Intervention Society and see if there are specialists in your area that can workup your chronic neck pain.




Sazid:
I have not consulted a doctor yet but I think I’m suffering sacroiliac joint pain. I feel stabbing pain while sneezing or coughing, sitting, or while rolling while sleeping at the left part of upper hip or lower back. I’m regular with my gym sessions and I do pull ups regularly.

Dr. Patel:
This could be the case. If simple gluteal strengthening exercises have not helped then you may need a diagnostic sacroiliac injection under x-ray guidance using just anesthetic to see if your painful symptoms reduce significantly. If this is the case proceed with the cortisone injections into the sacroiliac joint to control inflammation, manual medicine if it feels misaligned, or minimally invasive sacroiliac joint fusion for better stabilization.




Intikhab Alam:
Almost a year ago, while chasing a friend my left foot landed in a hole. At that time my leg felt stunned and painful, but later things were OK. But now I am having pain in lower back and left hip joint. In addition. I can't sit with a straight back. The pain starts to grow in the hip joint if I sit for long periods, plus carv muscle starts to give pain and left side of the foot has less sensation. I went to a neurosurgeon and an orthopedic surgeon. Both said I have less gap at lower back disc. One d3 and neogap medicine and the latter three different pain killers, but the problem is still there. Kindly advise what to do next.

Dr. Patel:
Get an opinion from a interventional pain management physician specializing in physical medicine and rehabilitation. The question is to delineate whether the hip or the lumbar spine is causing your active debilitating symptoms. I would call the International Spine Interventional Society and ask for someone in your area if available.




Jeanette:
I have been diagnosed with a tilted sacroiliac joint. Is there a surgical procedure to correct this? I have pain on a daily basis and have a di belt that works for short term relieve.

Dr. Patel:
If you have been diagnosed as having sacroiliac joint pain with either physical exam or diagnostic sacroiliac joint injection under xray guidance then I would consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Wayne:
I had lumbar surgery L4/L5 with fusion and hardware about 3 years ago. Pain never went away completely and has gotten worse. I have had two injections on my SI Joint with little pain relief. When I sit on a hard surface my lumbar and SI joint starts hurting. When I walk on hard surfaces, the pain starts. When I sleep on my right side it starts to hurt and I have a hard time sleeping. Working around the house too long causes pain. The least amount of pain is when I lay in the bed or in my recliner. I also have had cervical spine surgery 3 times but that's a different story.

Dr. Patel:
I would evaluate whether the L5-S1 facet joint could be causing your symptoms because of stress being created from the L4-5 fusion or the sacroiliac joint. If the diagnostic lumbar medial branch block to anesthetize the L5-S1 facet joint provides you with excellent pain relief within the first few hours on 2 separate occasions I would consider radiofrequency ablation technology to these medial branches. However if the diagnostic lumbar medial branch block is negative then have a diagnostic sacroiliac joint injection under xray guidance using just anesthetic. If positive, then consider minimally invasive sacroiliac joint fusion using the IFUSE product.



Wayne:
Unfortunately my insurance changed and I'm working with a new GP and Pain Doctor. They weren't with me during my progression with SI Joint Pain. My previous GP managed my pain. We began with Celebrex, then tramadol, then Lortab, then morphine, & now Fentynal patch 37mg & morphine for break through. I've done water PT 3 times, once paying for it myself. Once the PT rotated my pelvis into alignment and a very sharp pain that I was having went away, but the deep bone pain remained (2010). The Sacral Wedgy seems to relieve some pain. Otherwise the pain is a very deep ache, like intense bone pain. With flares, the pain radiates inside my thigh to my knee, radiates out to the hips, & can be very intense. I've used a Tens machine during flare-ups. In my mind's eye it's like the sacrum rubs against my pelvis bone. I say this because any movement that includes bouncing -- like walking or shopping or running -- makes it worse, but it isn't worse right away. It gets worse 2-3 hours after starting and grows in intensity over a few days.

I broke my sacrum in 1997 and I've had 4 other injuries to the tailbone since then (3 falls & rollercoaster incident -- had a molded seat with a hump in the middle, and being 5'3"" and 105 lbs at the time, I went up and my tailbone came down on the seat hump.) I had a terrible Salmonella infection in 2003, and maybe coincidence because I had just had my 4th injury to the tailbone (fell rock jumping on the beach in Hawaii). At that time I was taking 1-2 tramadol a day for the pain after standing during lectures.

In 2010 I had my 5th trauma to the tailbone (fell rollerblading) & that is when the pain got very bad. All my arthritis labs are negative, but when my SI joints, bursas flare, my hands also swell. So in 2011, we began treatment for Spondyloarthopathy. I've been allergic to 4/5 DMARDS and am currently trying Acterma w/out any response after 2 injections.

In early 2011, my previous pain doctor did steroid injections of the SI Joints and right and left & Greater Trochantar Bursa R & L (for about 2 yrs). By last April 2012, I had a crazy enormous reaction to the steroids and blew up like a whale. I then refused further steroid injections because every injection, my body blew up worse than the last. I gained 50lbs, moon face, hump on back, high cholesterol, & high blood pressure. In mid 2011, my job was exacerbating my symptoms because I had to stand for 8 hrs doing a job of carrying lab specimens & then doing 5-8 hrs of supervisory work while sitting. I won a workman's comp settlement and have been on disability since June 2012.

Finally, after getting to the point where I do nothing but lay in bed (Feb-March 2013), the pain has subsided to about a 3, but it's that deep bone pain & I'm on strong pain meds, but the pain is again controlled by the strong meds I'm on.

Anyway, my new pain doctor says I have NONE of the diagnosis I have been previously diagnosed with because all my labs are negative and my Lumbar / Hip MRI was negative. He said that injecting the joint and having 70% pain decrease is not diagnostic for what he calls SI Joint Disease. He said it is very dangerous that my previous physicians gave me steroid joint injections. He also states that because my pain medication didn't decrease (but my quality of life increased -- sleep at night, could exercise again, go out with friends/family again, I tend to ""overdo it"" when I don't feel pain & because the pain doesn't come right away I don't realize I've “overdone it” until it's too late) that the steroid injections didn't work. He says I need a positive MRI to diagnose this. Is this true? He says I have fibromyalgia even though the pain NEVER moves, it's always in the same place. I have had some medical massage and I do have some tight tendons from clenching but when I say "Oh, that's where it hurts", the MD Therapist tells me that it is the SI joint and there’s nothing he can do about that and to tell my rheumatologist that I need more anti-inflammatory help.

I have my Master's in Lab Medicine and am very much a career woman. Not being able to work is incredibly depressing to me. My new general practitioner told me to ""get over it"" and I should ""get out there and get going"". I'm a good-looking 41-yr old woman, who is smart, outgoing, & charismatic. But these doctors see me puffy & fat from steroids (which at 40mg takes 90% of the pain away during a flare and 10mg keeps pain controllable) and say, "Do you know how old you are? You're at the prime of your life and you need to snap outta it".

How do I prove to these doctors that my pain is real? I need a diagnostic test or proof that the lidocain injection reducing the pain 70-80% worked, but he doesn't believe it because my pain meds didn't decrease. I'm screwed. How can I have so much pain and my MRI of the hips/lumbar spine is negative? (By the way, I have sacralilliazation of the lumbar spine the lower 4 vertebra are fused like the sacrum.) How do I prove hypermobility? How do I explain a negative MRI with so much pain? I may have some fibromyalgia, but I don't think it hurts this much and only in one place?

Please tell me what to do besides lay in bed. I got the sacral belt and I'll start wearing that. I don't want more pain medication. I want to intelligently present my situation to these new doctors. I have a referral to a sports medicine center but I haven't gone because I'm afraid they are not SI Joint specialists and might react as these two new docs have.

Dr. Patel:
My advice is since you have been on pain meds for so long wean yourself off by one pill per week and then repeat the diagnostic injection into the sacroiliac joint. If the diagnostic is positive he may be inclined to performing the treatment. However the only other option is to consider Bipolar radiofrequency ablation of the lateral branches at S1, S2 , and S3.




Chuck:
I have 1 malformation and a compressed disk in my lower back, also prefical neuropathy. What can I do for all the pain I am going through? Do I have to have a spinal fusion surgery?

Dr. Patel:
I would see an interventional spine specialist to evaluate if a less aggressive treatment option is available to manage your painful symptoms. Call the International Spine Intervention Society and ask for someone in your area if available.





March 2013

Darla:
I have had chronic back pain over 5 years. I've been to an MD who has given me different meds; two back pain specialists; had 4 different injections (facet blocks, steroid); 3 chiropractors (active release therapy helped for a short while); a low back pain specialist and physical therapy – none of which helped. I've had cortisone shots in both hips and back (made the pain worse and caused horrible achiness and pain up and down legs for months afterward); had xrays, MRI, discogram, CT scans....been to a neurosurgeon and an orthopedic surgeon, who all say the same thing: “I don't know what's wrong with you.” I am a 49 year old school teacher who is up and down on my feet most of the day but cannot do anything out of the ordinary w/o pain in my back, right hip and right groin area. If I stand or sit or lie down too long I'm miserable. I cannot bend over to brush my teeth or wash my face at the sink w/o pain. I can't walk, do yoga, run, play volleyball...nothing that I used to do anymore. I know that I'm getting older but, I don't believe that this pain is normal. I've been gluten free for over a month and dairy free for over a week, and still have the same symptoms of pain. I wake up at night because I'm not comfortable on either hip, or back, or stomach and it’s very hard to turn over. Please help!!! Where do I go from here??

Dr. Patel:
If you have had a negative lumbar discogram not demonstrating concordant provocation of your typical symptoms and your pain is lumbosacral that refers into the hip worse with standing, sitting or walking, then have a diagnostic sacroiliac injection under xray guidance with just 1.5 cc of anesthetic into the joint. If the diagnostic sacroiliac joint injection demonstrates significant pain relief of your typical symptoms then consider minimally invasive sacroiliac joint fusion using the IFUSE Product.




Patrick:
I live with sometimes severe sciatic nerve pain in my right leg and groin area and am scheduling a steroid epidural injection soon. Been out of the loop for about 5 yrs. and am wondering what is a good medication for sleep?

Dr. Patel:
Good medication for sleep is Elavil. Hope the steroid injection works for you.




Cheryl:
My doctor gave me an SI joint injection without any x-ray. I am 5'3", 125lbs. This did not work for me. Is it common to not use x-ray?

Dr. Patel:
Not anymore. Gold standard now is to perform sacroiliac joint injections under x-ray unless pregnant, then ultrasound or blind technique would be the best options.




John:
What is the expiration of an MRI diagnostic exam? Can I use one that was taken 60 days ago?

Dr. Patel:
Yes. Unless the symptoms change in location, use that MRI to help correlate your clinical symptoms. Findings on MRI’s have been proven to take years to see interval changes.




Cynthia:
I am having surgery on my L5 herniated disc. Will this fix the numbness associated with the leg pain from the S1 joint as well??

Dr. Patel:
It may not. Numbness can take years to go away. If it is pins and needles or shooting or progressive weakness then surgery makes sense. It is possible the lumbar radiculopathy caused some of the gluteal muscles to become weakened creating a sacroiliac joint dysfunction. Too early to tell until you reassess the symptoms 2 to 3 months post microdiskectomy.




Yousef:
Here are my symptoms: • Loss of cervical lordosis • Loss of normal hydration T2 with hyper intense signal intensity of the cervical discs, with mild narrowing of C6/C7 disc, no disc prolapse seen • Mild diffuse C6/C7 disc bulge with small posterior marginal osteophytes .causing mild anterior theca indentation & moderate encroachment upon LT exit neural foramen • Normal cervical cord According to the information above., do I have to undergo surgery.?

Dr. Patel:
Not sure. Some of these findings may be pre-exisiting and some pre-existing and substantially aggravated. Someone has to be able to correlate your symptoms with the structural findings.




Praveen:
My 25 year old sister is recently suffering with backache. Her MRI results showed:
1) Sacralized L5 Vertebra.
2) Discal bulge, broad based central/jright paracentral protrusion, annular tear at L4-L5 with compression of thecal sac, right traversing root.
3) Narrowing of spinal canal, lateral recess at L4-L5, L5-S1.
Please suggest further proceedings. We have consulted a doctor from a reputable hospital and he is suggesting surgery.

Dr. Patel:
Does the patient have severe pain from the buttock down the side of the leg on the right side worse with sitting or standing and walking? If yes then I would suggest an operation if an L5 selective nerve root injection on the right side has not helped.




Lianne:
I was a pedestrian and hit by a truck about 15 months ago. I've had 3 SI injections (right side) and just had nerve ablation with a PM doctor 2 weeks ago. I've also had PT throughout the year for this injury (along with PT treatment for my hip, knee, and foot). The nerve ablation was very painful and I'm still in a lot of pain from the procedure. What's the next step after this ablation should it not work for me? I really need to get back to living a normal, pain-free life!

Dr. Patel:
As long the diagnostic sacroiliac joint injection using anesthetic only demonstrated significant pain relief with functional activities then I would proceed with minimally invasive sacroiliac joint fusion using the IFUSE Product.




Jessy:
My daughter is 25 yrs and doing her final year for BDS in Kerala . She is having partial sacralisation L5 vertebra is seen with fusion of right transverse process with right sacral ala. as per MRI report which was done in October 2012. She had her first episode of pain in 2007 and 2nd episode in October, 2012; 3rd time in March 2013. On and off she is having pain she can tolerate, but these three times she had severe pain. Her ortho prescribed pain killers and bed rest. Please tell me if there is a surgery to control/eliminate her pain and where it is available.

Dr. Patel:
I think a simple hamstring stretching program while lying supine 30 minutes a day on each leg should help relax the lower lumbar and sacral muscles. This should make a great difference in preventing flare-ups. It worked for me!




Petro:
I have had a spinal fusion, lower 4 lumber vertebra but have pain in the waist area. Can this be sacroiliac pain, and if so, what can I do to get rid of it?

Dr. Patel:
Yes. Sacroiliac joint seems likely from adjacent segmental stress. Option that may be the best is to consider RFA of the lateral branches at S1, S2, and S3. If your symptoms fail to progress, consider a minimally invasive sacroiliac joint fusion using the IFUSE product. However, gentle manual medicine should be the first option if it feels out of place.




Michael:
Could the iFuse treatment be used on a patient who has already had L5 - S1 fused with rods and screws in place? This surgery left me in more pain then I was before, and I have been taking morphine and loratabs for the last 5 years, and still have severe pain with activity. I have recently seen a neurosurgeon who said L4 is now bad due to the fusion, and L4 taking all the wear and tear. He tried to do an MRI on my back, but having the rods and screws in my back messes up the pictures, and he finally had me have a mylogram, followed by a CT scan.

Dr. Patel:
If your pain is emanating from the sacroiliac joint because of adjacent segmental stress from interbody fusion at L5-S1 then yes, I would consider minimally invasive fusion using the IFUSE Product. I would also have a diagnostic sacroiliac joint injection under x-ray guidance to confirm this is where your symptoms are most likely emanating from.




Joanne:
My 23 year old daughter has had 2 lower back surgeries and has herniated discs at the present time which cause a great deal of back and leg pain. She recently went to a physical therapist who said her si joint was out of place. She worked extensively on the si joint (area) and now my daughter has a great deal of pressure on her tailbone causing a lot of pain. In all the years of pain she has never had tailbone pain. Could this be the result of the therapist trying to ""put the si back in place""? She will be seeing a different therapist soon. Any input to help our understanding will be greatly appreciated.

Dr. Patel:
If she had severe leg pain from a symptomatic herniated disc even after 2 low back surgeries the question is: were the surgeries microdiscectomy or fusion of the lumbar spine? In the presence of microdiscectomy I would be concerned about scar tissue around the nerve tissue. This could be the reason for the persistent leg pain. In the presence of an interbody fusion then I would worry about the sacroiliac joint being the source of the pain from adjacent segmental stress from the interbody fusion. Manipulation is a good option for the presumption if it is sacroiliac joint pain. However if the treatment options are not working well obtain an appointment with an interventional spine specialist in your area to perform a diagnostic sacroiliac joint injection under x-ray guidance.




Sandra:
I am currently 53 years old. I began working for a Workers Compensation MCO June 16, 1999 as a Telephonic RN Case Manager. The company was paperless, meaning we did everything from our desktop computer (i.e., faxing, documents scanned into inbox by support staff, etc.) so we could be more productive. I basically sat at my desk 6-9 hours per day on the phone and computer. We were told we were allowed to take two fifteen minute breaks per day but I was lucky to get one per day due to the size of my caseload and the performance standards set by the company which were monitored by coded computer entrees. I was involved in 2 MVA July 2006 and February 2007. In both, my car was rear ended. Even though my chair was way too big for me both in depth and width (I am just under 5'2"" and weigh 98lbs) and gave me no support, I had never had any problems/complaints of right low back or right buttocks pain until after these 2 MVA. Gradually the pain became more severe and finally intolerable. At first it would start 2-3 hours after starting working work. I asked to have my hours decreased from 36 to 32 hours per week beginning June 2007 so I could work shorter days. My decreased hours were granted but my caseload remained the same size so it was harder to take my break. As time went on, my pain would begin within an hour of starting work and became more severe as the day went on. I also started getting numbness and tingling in my right foot as the pain became more severe. I began requesting to Telework in 2008 so that I could devise my own sit /stand workstation and avoid the 40 minute commute each way to and from work. I asked at least 15 times over the next three years and was denied, although other employees did Telework because they had a longer commute. I was asking because sitting was hurting me. In March 2009, I leaned on my desk while pushing off with my left leg/foot attempting to get out of my chair. When I tried to place my right foot on the ground, I experienced a sharp, shooting pain from my right foot to my low back. I was unable to bear weight on the right foot/leg for 40 minutes. Even toe tapping would elicit this pain. This happened several times over the next 3 years, although not as severely and not the same length of time. This incident led me to see a neurosurgeon and I had a surgery 11/20/09 -- a Right Hemilaminectomy L5-S1. They found I had conjoined L5 & S1 root sleeve. I did a gradual return to work 1/7/10 starting at 4 hr/day for 4-5 weeks then increased by half hour/day each week after until I was back to regular 32 hour/wk. I felt that my symptoms prior to surgery, which pretty much had followed the sciatic nerve from the right low back through the right buttock with numbness/tingling in the right foot, had improved after the surgery but began to exacerbate after I came closer to my regular hours. The pain really started escalating and expanding by May 2010 after I had returned to work regular hours, 32hrs/wk for several weeks. I again pleaded for the accommodation to Telework and my Family Doctor asked for this on FMLA paper work. Again I was denied. At this point my pain was not only following the sciatic nerve root but was also was encompassing my entire right buttocks to my posterolateral hip to the top of my posterior femur. I had several Lumbar ESI and then my surgeon referred me to a PM&R in October 2010 for treatment of what he thought was SI Joint Dysfunction. I had an SI Jont Injection 11/3/10 with temporary (4hr) relief but no lasting benefit. I was back in physical therapy for the 5th or 6th time. By mid December 2010 I was in such severe pain that my family doctor and PM&R agreed I should be off work for 2 weeks. When I returned to work the end of December, I was again in extreme pain within 2-3 hours and was taken off work for several days with a subsequent gradual return to work beginning at 4hr/day & increasing each week by one half hour per day. My family doctor and PM&R also requested that I be provided a Standing Work Station. My work asked to have a company affiliated physical therapist come in to do an evaluation prior to making a decision. This was done 3rd week January 2011. His report stated that due to my rapidly deteriorating condition, expense of standing station and space required he did not recommend but would suggest a kneeling chair, I received a kneeling chair 3/1/2011. I forgot to note that my pain had spread to my groin by November 2010. My symptoms/pain continued to worsen until I could not stand it. I left work abruptly on 4/5/11 because I could no longer stand the pain in my right hip and low back. My doctors originally thought my problems were related to my back due to significant deterioration shown on my Lumbar MRI, February 2011. My previous Lumbar MRI's 5/21/07 and 4/1/09 had shown that L1-2, L2-3, L3-4 and L4-5 were normal but found a L5-S1 annular bulge with mild facet arthropathy. While my Lumbar MRI 2/16/11 showed Lower Thoracic and Lumbar Disc Dehydration with mixed Anterior Spondylotic Disc Displacements, L1-2 & L2-3 showed no Posterior Displacements, L3-4 Level showed no Posterior Displacement but did show mild Facet Arthropathy and a right Extraforaminal Cyst @ L3, L4-5 Level showed no Posterior Displacement but did show moderate Facet Arthropathy greater on the right, L5-S1 Level showed a prior Right Hemilaminectomy, Right Inferior Foraminal Disc Protrusion near /abuttting the Right Foraminal L5 Nerve Root with mild Right Foraminal Narrowing with Right Anterior Extradural and Right S1 Perineural scarring, my hips showed small Femeroacetabular Osteophytes. Dr. Tobler planned to do an Interbody Fusion and Total Discectomy at L5-S1 and wide Decompression of the Foramen and Disc on the Right with possible Bilateral Interbody Cages but he did not seem to understand why my pain had radiated from just the low back and posterior buttocks to include my right outer hip and right groin. So I had an MR Arthrogram Right Hip done 5/17/11 which showed a mild Right Cam type Femoroacetabular Impingement with low grade Arthrosis and mild Osseous Spurring, Right Superolateral Acetabular Labral Tear, Right Anterosuperior Degenerative Labral Tear /Fraying, mild to moderate Chondromalacia, small Subchondral Cyst Lateral Acetabulum, Overlying Focal Chondral Defect, slightly broadened /thickened Right Femoral Head-Neck Junction with Bump Cyst and Subcortical Cyst with surrounding Fibrovascular Stress Reaction at the Femoral Head-Neck Junction. I went back and forth between Dr. Tobler and Orthopaedic Surgeons. Finally everyone agreed that my hip should be addressed first and hopefully after hip surgery my pain will be abated and I will not need back surgery. I had a Right Total Hip on 5/8/12 @ OSU Hospital East followed by physical therapy May 21, 2011 to October 2011 which originally was for the hip but eventually included the low back. My groin pain has improved after hip replacement but not the right low back and right buttock pain and the numbness and tingling in my right foot which was confined to the outside of my right great toe post lumbar surgery is now covering my entire bottom right foot again. I have since seen 2 other neurosurgeons since Dr. Tobler is no longer covered by my insurance. They both are recommending a L5-S1 Interbody Fusion with Spinal Cord Stimulator Implant. I have not worked since 4/5/11. Now I cannot tolerate sitting more than 10 minutes without exacerbating my pain from 5 -6/10 to 8-10/10, I also am not able to stand or walk without the same effect. The only halfway comfortable position for me is lying in a recliner. I filed workers comp 4/11/11 for aggravation pre-existing lumbar L5-S1 and was denied and terminated by employer. I filed SSDI and was denied and told with my education I could do a sedentary job. I had Independent Medical Exams for car insurance and workers comp in which both examiners said this is normal deterioration. I had an SI Joint Injection November 2012 with 4 hours 95-100% pain relief. Fortin Finger Test is positive. I have lost my ability to earn a wage. I have lost my life, basically homebound except doctor appointments. I watched Dr. Shamie's webinar and think my symptoms are SI Joint related as far as the main generator of pain symptoms.

Dr. Patel:
The sacroiliac joint could be the source of the pain. I would recommend a diagnostic sacroiliac joint injection under x-ray guidance using anesthetic only. If your worst symptoms are significantly improved with functional activities then I would recommend minimally invasive sacroiliac fusion using the IFUSE product.




Sandra:
1) I believe my work not only exacerbated but contributed to my current health condition. Do you agree?
2) I believe that a L5-S1 Fusion will exacerbate my pain /symptoms. I believe the SI Joint is my major pain generator. Do you agree?
3) I think the iFuse may be a better option for me over Lumbar Fusion currently. Do you agree?
4) I believe I am currently disabled and have been since 4/5/11. Do you agree?
5) Do you know a certified, reputable physician in or near Cincinnati, Ohio who could evaluate me and perform the iFuse on me.

Dr. Patel:
1. Not sure.
2. The sacroiliac joint could be the source of your pain. I would recommend a diagnostic sacroiliac joint injection under x-ray guidance using anesthetic only. If your worst symptoms are significantly improved with functional activities then I would recommend minimally invasive sacroiliac fusion using the IFUSE product
3. Depends on your symptoms and results of diagnostic sacroiliac joint injection.
4. Zeeshan Tayeb, DO.




Trish:
Especially when I am sitting I am having really bad pain in the front of both thighs. I have had two previous back surgeries (laminectomies) which were not successful. Can you please help me?

Dr. Patel:
If you have posterior buttock pain and anterior thigh pain together this could be emanating from the L4 nerve root from severe foraminal stenosis at L4-5 or lateral recess stenosis at L3-4. This could also be referred pain from the sacroiliac joint. If your specialist feels the sacroiliac joint is more of a possibility then I would recommend a diagnostic sacroiliac joint injection under x-ray guidance using anesthetic only. If your worst symptoms are significantly improved with functional activities then I would recommend minimally invasive sacroiliac fusion using the IFUSE product.




Habeeba:
My wife is suffering severe pain constantly on the left side of the face last 4 years. All ENT, Dental, and Ortho reports, including MRI, are normal. Painkillers and antibiotics do not work. Please give me advice.

Dr. Patel:
I would seek an appointment with a neurosurgeon who specializes in trigeminal neuralgia. There are other cranial nerves that can cause facial pain. That may have been overlooked. Make sure this is what they deal with primarily.





February 2013

Darrell:
I got Hemilaminectomy on the left side with L5-S1 Microdiscectomy about 5 weeks ago in Thailand. I am now back in Afghanistan with very light duty. I can get up and walk or sit down whenever I want, and I don't have to lift anything. I went to the best hospital in Bangkok and one of the best Neurosurgeons, but there was still a lot that was not passed on to me due to the language barrier. He said he took the entire disc out, but he didn't mention fusion or anything and he didn't put anything back in place of the disc. Is this common? I feel OK. I still have some pain and numbness down my leg and calf, but I can deal with it compared to what it was. I just hope you can tell me what kind of physical activities I will be able to do once I am fully healed and when that will be. I asked the Dr. if I would be able to run marathons and fight competitively again, and he said yes. He said I should be able to start running again after 6 weeks. I'm reading a lot on the Internet now and it just dose not sound like people do physical activities like that after that type of surgery. If he didn't fuse the bone back together and didn't replace the disc with anything how stable will it be in the future? Is it going to cause damage to other bone by grinding together? I hope you can help me to be more informed about the surgery I just had and what I can expect in the future. Thank you!

Dr. Patel:
You had a hemilaminectomy with microdiscectomy at L5-S1 for left radicular pain most likely radiating down the posterior buttock thigh and calf probably worse with sitting and leaning forward and improved somewhat with standing and walking. At this point the numbness and tingling can persist for months to years. Medications like Neurontin or Lyrica may be useful if the tingling becomes more painful. With microdiscectomy they remove the herniation and additional nuclear material as they see fit. Risk of reherniation is between 10 to 15 percent. I would avoid bending forward and use proper lifting techniques. A physical therapist can educate on this. Best time to run is probably in the morning rather than in the evening. Studies have shown the disc is more resilient in the morning. Improve hamstring flexibility and hip/pelvic flexibility. If you reherniate and develop leg pain and the disc height is pretty narrowed a fusion may be the next step. Then your risk of developing adjacent segmental pain above and/or below the fusion increases and pain control may become a problem. Make this your last surgery! In the future the disc will get shorter in height because disc degeneration will accelerate but this may not become a symptomatic finding. If you develop back pain along your belt line worse with standing and walking it is conceivable that the facet joint at L5-S1 could be the source of the pain because of the decrease in disc height placing increased loads on the facet joint with simple activities. Also there is the risk of scar tissue developing around the S1 nerve root. You may develop worsening pain down the leg. If this happens you will need an MRI of the lumbar spine with and without contrast to see if there is new herniation vs scar tissue. If it is scar tissue then contemplate nerve root injections with medications like Neurontin or Lyrica. If that does not work for at least 6 months then a spinal cord stimulator trial may become a more appropriate next step.




Scott:
How long after my sacroiliac joint injection would I be a candidate for ifuse? I got my shot on 2/5/13.

Dr. Patel:
If you have not noticed significant changes after 1-2 therapeutic sacroiliac joint injections under x-ray guidance and have utilized physical therapy for this diagnosis and have established the diagnosis with physical exam and or a diagnostic injection under x-ray guidance, I would suggest IFUSE to become the next step.




John:
I am age 36 and my pain started a year ago with having a baby with epuidural. The MRI shows bulge at L4/5 in the ventral sac without neutral compression. Every single day I have pain and only get relief when I take Endone for a couple of hrs, otherwise always in pain: when I sleep, walking increases it. The bone scan shows arthritis in both glenohumeral.

Dr. Patel:
It is possible if your pain is lumbosacral in nature that the sacroiliac joint could be the source of your pain. Spontaneous vaginal deliveries could be the source of your pain rather than the epidural depending on the location of symptoms. I would recommend you see a physical therapist and have some manual therapy or pelvic stabilization exercises and see if this helps to alleviate your symptoms. If not, get a diagnostic sacroiliac injection under x-ray guidance. If positive for a significant reduction of your typical symptoms then get corticosteroid preparation injected into the joint 1-2 times. If you fail to progress, consider a minimally invasive sacroiliac joint fusion using the IFUSE product. However if the pain is located where you had the epidural have an interspinous ligament injection at the exact level the blind epidural was performed. This may help to alleviate the symptoms.




Dave:
My dad underwent an operation of L5S1 5 years back. Now he has started having the same pain. After getting him checked again, the doctor is recommending him to go for an operation again. Is it advisable to undergo the operation again??

Dr. Patel:
It depends. If he is having more pain with standing and walking and it is along the low back region, have the facet joints at L4-5 evaluated. Typically a diagnostic lumbar medial branch block is performed under x-ray guidance. If you notice an 80 to 90 percent of your low back symptoms with standing and walking on 2 separate occasions for consistency then I would recommend radiofrequency ablation of those medial branches at L4-5. However if the pain is lumbosacral in nature, worse with sitting along with standing and walking, it is possible that the sacroiliac joint could be the source of the pain. The fusion at L5-S1 if solid could be placing stress to either the segments above at L4-5 or below at the sacroiliac joint. Proceeding further you would need a diagnostic sacroiliac joint injection under x-ray guidance. If positive then I would recommend a corticosteroid instillation of medication into the sacroiliac joint with a pelvic stabilization program. If your dad fails to progress then consider a minimally invasive sacroiliac fusion using the IFUSE product.




Angela:
Doctor, physio, Osteo, Acupunture and then a back specialist in NZ who after a year gave me an MRI which concluded in a prolapsed disc. He recommended certain exercises to do which aggravated it more, then I had injections in the disc which only deterred the pain for 1 week. I am really suffering now which is debilitating and impacts on me working. I was taking pain medication Tramadol and then was prescribed Lyrica Pregablin to try which is not allowing me to function properly throughout the day and I still can't sleep without shoving pillows under my legs and back to try to get comfort. I am desperately trying to do all the right things but saw this and want to know if this surgery could help me. I have my MRI on a disc which can be viewed by you or someone local to our area. I really look forward to your response and thank you.

Dr. Patel:
Sometimes the fall can be from a prolapsed disc. However if you are not having severe pain from the buttock down the leg this condition could be in remission. However the fall could have irritated the sacroiliac joint. I would recommend a diagnostic sacroiliac joint injection under x-ray guidance. If positive for an 80 to 90 percent reduction of your concordant symptoms with functional activities then have corticosteroid placed into the joint 1-2 times with an appropriate physical therapy program. If you fail to progress then consider a minimally invasive sacroiliac joint fusion using the IFUSE product. Please read my article on spine-health on sacroiliac joint injections and sacroiliac joint dysfunctions.




Rajshree:
I am currently suffering from low back pain. It runs down the side and back of especially my left thigh to the knee. MRI shows annular bulge between l4- l5 impinging nerves on both sides. Please advice treatment.

Dr. Patel:
If your pain is worse with standing and walking and the mid lumbar back pain is worse than the lateral thigh pain, have a diagnostic lumbar medial branch block performed under x-ray guidance at L4-5. If you notice an 80 to 90 percent of your low back symptoms with standing and walking on 2 separate occasions for consistency then I would recommend radiofrequency ablation of those medial branches at L4-5. However if the pain from the buttock down the lateral thigh and even the lateral calf is the worst feature then consider a bilateral L5 transforaminal epidural 1-2 times under x-ray guidance. If you fail to progress consider a surgical consultation to see which options are available.




Mary:
I have herniated (ruptured) L5 S1 disc and had pain through right buttock, hamstring, calf and ankle. I have taken epidural cortisone injection which helped but right half of my foot is still numb and pain still comes back and goes. I have to go for follow-up yet and start rehab but I am worried if its going to heal or not. Thanks for any suggestions, tips.

Dr. Patel:
It seems you are suffering from a right S1 radiculopathy secondary to disc herniation at L5-S1. If you have had 1-2 right S1 transforaminal epidural injections with minimal relief in conjunction with a McKenzie style stabilization program for your symptoms and you have good disc height consider a hemilaminectomy with microdiscectomy at L5-S1. With or without surgery there is never a guarantee that nerve will completely heal or not. If your symptoms are manageable continue with the conservative course. If they worsen consider the surgery. Be prepared for a fusion if the disc height is too narrowed to perform a microdiscectomy.




Dorothy:
This is not about the Sacroiliac, but I hope you can answer my question. I have just finished having 3 epidural steroid injections for low back pain. It It’s been 1 week since my last one and I still have weakness in my legs and bladder incontinence is worse -- is this normal and how long can this last?

Dr. Patel:
If you have not had these symptoms before and they occurred in proximaty to the epidural injections I would discuss this with your physician who performed the procedure. If you are having headaches you could have a spinal puncture causing CSF to leak, potentially causing these symptoms. However your imaging studies suggest spinal stenosis and if you have progressive leg weakness you may contemplate a surgical opinion secondary to the weakness and worsening bladder symptoms. I have seen worsened bladder symptoms for up to 3 to 5 days after a bilateral S1 transforaminal epidural injection in my clinical experience.





January 2013

Lynn:
I have pain in my back, hip pain that goes down my leg and sometimes severe pain in my hip joint. I have been to different doctors and had an MRI. They all say they don’t really know what’s going on, but they think it could be Ankylosing Spondylitis?? In other words, arthritis. Last doctor wasn’t sure what it was and wanted to inject me but I refused: if she wasn’t sure what was wrong, what was she injecting me with?? The pain in my hip joint affects the way I walk sometimes, and when the back pain starts it's like muscle spasms. I'm usually flat on my back for several days. Maybe you can help me?

Dr. Patel:
My advice is to seek an opinion from an interventional spine specialist. The first questions is: are you having more pain above the buttock region or more from the buttock down the leg and in which areas of the leg do you notice the pain. Second: which functional activities increase the intensity of the pain the greatest, like standing and walking or sitting and leaning forward? The differential is endless. It can range from a joint issue from the lumbar region and/or sacroiliac joint, to a radicular pain syndrome emanating from the L5 or S1 region just to name a few. My advice is call the International Spine Intervention Society and ask for a physician close to your area for an opinion. Hope this helps.




Deborah:
I was treated with an injection into the SI yesterday and, compared to the Caudal epidural, so far it doesn't look like this has helped. I know it can take a couple of days but with the Caudal my pain relief is fast. So if this doesn't help me then it isn't my SI .....correct ? I'm at my wit’s end trying to keep my job. I’m on my feet all day and in pain with every step. Then when I get home and sit down I can barely put weight on my left leg. I thank you for any help or suggestions you can give me. BTW, I had an injury in 1986 (herniated disc L5S1) and had surgery in 1987 (lumbar laminectomy). Had ongoing problems ever since but now can barely walk.

Dr. Patel:
Typically the current gold standard to ascertain whether the sacroiliac joint is correlated with your typical symptoms is the physical exam demonstrating exacerbation of at least 3 of the 5 provocative sacroiliac joint maneuvers. These would include the pelvic thigh thrust, compression, distraction, gaenslen, and FABRE. The second is an anesthetic block using either lidocaine or bupicivaine into the sacroiliac joint under x-ray demonstrating a significant reduction in your concordant symptoms with functional activities. The steroid injections into the sacroiliac joint are not diagnostic but therapeutic injections and serve no diagnostic validity. I would also consider obtaining an updated MRI with and without contrast to see if scar tissue surrounds the L5 or S1 nerve root. This could be radicular in nature secondary to instability at the laminectomy site, nerve root fibrosis from previous surgery, or new herniation at L5-S1, or sacroiliac joint in origin. You will need to see an Interventional Spine specialist in your area that can help to further delve into your symptoms and utilize evidence-based medicine from a procedural standpoint to help associate your current set of symptoms with the pathology. If you need a reference, call the International Spine Intervention Society and request a physician close to your area if available.




Lenora:
What is the recovery process after si joint infuse? How long off work, clerical, etc?

Dr. Patel:
Weightbearing restrictions are typically 3 weeks. You will work with a physical therapist for functional rehab. Return to work is not standardized; it depends on functional improvement in pain, no complications, and occupation type. This would be up to your surgeon.




Matthew:
My rheumatologist says I have spondalarthropathy. After multiple MRIs and various doctors’ opinions my only option is to take Enbril or a similar drug. It’s been close to a year of taking Norco but the pain has ramped up and I'm also taking Meloxicam and baclofen to help with spasms, which occurred before upping the dose of Norco. When not on the medication I'm unable to get out of bed. The pain is sharp, stabbing and aching. As I move I trigger a very sharp stab which brings on a simultaneous clinch in my back and side spasms which is unbearable, so I'm on the narcotics. Enbril scares me but taking the meds I'm on now isn't a walk in the park either. Uncomfortable side effects make this temporary solution seem unsustainable. I'm often dizzy, weak at times and nauseous. Here’s my question: nothing I have read or those I talk to say anything about sharp acute pains in the back and side with spasms. My MRI doesn't show fusing, bulging, or really anything except swelling all along the spine. However, there is Heterogeneous fatty replacement of bone marrow bilaterally involving the ribs at the level of the costovertebral junctions. A lot of unusual bone marrow patterns. What is really going on and will Enbril remove the pain? Nobody seems to have the answer. If Enbril doesn't help, I have no solution for my problem other than these narcotics which seem to be losing their ability to be effective. Please help any -- comments would be appreciated.

Dr. Patel:
If you have a seronegative spondyloarthropathy that the rheumatologist believes is concordant with your painful symptoms then I would follow his/her recommendations. If you have persistent pain along the sacral region, worse with sitting or even standing and walking, consider treatment to the sacroiliac joint. This would include steroid injections under x-ray, physical therapy in the form of pelvic strengthening exercises, manipulation, and minimally invasive sacroiliac joint fusion. I would take the Enbril and decrease the narcotics. The Enbril could cure your peripheral joint pain since it seems you have a systemic inflammatory disorder.




Adrian:
I have chronic lower back pain on left for 20 yrs after manipulation by 'alternative' therapist. Recently I read that it could be that my SI joint was dysfunctional and all the signs were there (except any pain in the actual joint itself). I started on don tigny SI joint exercises and now have pain in SI joint. I now use a SI brace all day (even in bed). Can I have seriously injured my SI joint doing these exercises? I am not looking to make any claims just want to know if this will heal on its own.

Dr. Patel:
Pain emanating from the sacroiliac joint is a complicated issue. The pain could be emanating from the ligaments or even the muscles supporting the joint or the joint itself. Imaging studies will provide little information if the sacroiliac joint has subluxed. However, if you feel the sacroiliac joint is your pain generator, have a diagnostic sacroiliac injection under x-ray guidance to confirm your suspicion. Please refer to my sacroiliac joint injection article on spine-health. If the relief is almost complete for a few hours with functional activities entertain the idea of a therapeutic injection with your exercises. If that fails consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Carole:
Can Sacroiliac Joint extreme pain be genetically connected to my father? I am 61, in constant pain, forced into disability with a herniated disc and degenerative disc disease. I remember being 10 years old, my dad coming home from work in extreme back pain daily. He would ask me to sit on his back and it would lessen his pain. I have sciatic pain all the way down my right leg and I have fallen 6 times in six years. Right side just gives out. On 7.5/325 Vicodin 3 times a day for six years.

Dr. Patel:
Not sure of the genetic lineage with sacroiliac joint pain. However if you feel the sacroiliac joint is your pain generator have a diagnostic sacroiliac injection under x-ray guidance to confirm your suspicion. Please refer to my sacroiliac joint injection article on spine-health. If the relief is almost complete for a few hours with functional activities entertain the idea of a therapeutic injection with a pelvic stabilization exercise program. If that fails consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Vicky:
I had a fusion of L4, L5 and S1 - why do I have tail bone pain that I never had before and now numbness in both legs and still major back pain? Is this normal?

Dr. Patel:
If you have a solid fusion at L4-5 and L5-S1 and still have major pain consider the sacroiliac joint as a potential pain generator secondary to adjacent segmental stress transfer from the fusion onto the sacroiliac joint. Consider a diagnostic sacroiliac injection under x-ray guidance to confirm your suspicion. Please refer to my sacroiliac joint injection article on spine-health. If the relief is almost complete for a few hours with functional activities entertain the idea of a therapeutic injection with pelvic stabilization exercises. If that fails consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Arpita:
I've been getting needle prick pain in my foot sole, a tingling pain that lingers. My foot veins also swell. Any solution? I'm in pain...

Dr. Patel:
Foot pain could a peripheral nerve or a nerve along the lumbar spine. Have an electrodiagnostic evaluation performed and see what that shows first.




Diane:
I think my lower back and hip pain is caused by my Sacroiliac joint. I had a Laminectomy done in Sept. but am still having pain in my buttocks, hip area, and leg down to my knee. Should I go back to my neurosurgeon and have him do another MRI to see if that is what is causing my pain?

Dr. Patel:
If you feel the sacroiliac joint is your pain generator have a diagnostic sacroiliac injection under x-ray guidance to confirm your suspicion. Please refer to my sacroiliac joint injection article on spine-health. If the relief is almost complete for a few hours with functional activities entertain the idea of a therapeutic injection with a pelvic stabilization exercise program. If that fails consider a minimally invasive sacroiliac joint fusion using the IFUSE product.

However you may need an updated MRI of the lumbar spine with and without contrast to see if you have re-herniated your intervertebral disc or scar tissue has developed around the nerve root.




Daniel:
Would like to find an Ortho surgeon located close to my location who actually performs the MIS iFuse procedure. I have defined mechanical problems with a LSTV where the left proximal transverse process from a lumbarized S1 segment make a pseudoarticulation joint with my ilium which has been verified via attempted left SI fusion in 1991. I have hardware (plate with 5 screws) which is mounted on my ilium and is screwed into my sacrum. My 1st surgery on my spine involved fusions to stabilize the LSTV in 1982 via a solid fusion of L5 to S1/L6, and S1/L6 to S2 (fusion is solid verified by during 1991 attempted left SI fusion). 1983 L5 fused to L4, 1989 L4 fused to L3 (this L3-4 fusion is not solid, and it creates left L3/4 mechanical pain). I do not have radiating pain into my left leg, but have leg pain with increased activity. Thus 2 sources of mechanical pain on the left side. I have been maintained with opiate regimen, but this is no way to live. Have CLL, but do not want to follow through with IV chemo in order to exist with this spinal pain. My Hemo-Onco has cleared me for MIS surgery for a knee, but I need my SI joint repaired, and the Left L3/4 fusion. Since S2 to L4 is a solid fusion, the fulcrum effect creates much more SI pain then previous to any surgeries. I have to address any possible help with the Left SI, or just cave into the CLL. OIC from the opiates keeps my life rabid along with the pain. I can either contact my 1991 surgeon who attempted to fuse my left SI, or consider iFuse. Please advise if there is a Dr close to Wilmington, NC who is an SI expert. Thank you for your help.

PS - The last Ortho recommended to me by iBone was located in Raleigh, NC but he isn't an SI expert and has not used the iFuse procedure. I need an SI expert. Regards, and thanks again in advance.

Dr. Patel:
I would honestly call the SIBONE website and talk to a representative. I know of one physician in North Carolina that has performed this procedure and speaks to surgeons in training courses.




Apurva:
I have pain around left SI joint for 3 yrs. It’s a dull, aching kind of pain. On and off phenomenon, relieved on rest, aggravated on prolonged sitting, prolonged standing and in supine while lifting pelvis. Could you tell me what can be the possible diagnosis? Recent LS x-ray was normal.

Dr. Patel:
It could be a sacroiliac joint dysfunction. Please refer to my articles on sacroiliac joint dysfunction. If you feel the sacroiliac joint is your pain generator have a diagnostic sacroiliac injection under x-ray guidance to confirm your suspicion. Please refer to my sacroiliac joint injection article on spine-health. If the relief is almost complete for a few hours with functional activities entertain the idea of a therapeutic injection with a pelvic stabilization exercise program. If that fails consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Tammi:
Do all surgeons require you to quit smoking two weeks prior to scheduling, the ifuse surgery?

Dr. Patel:
I think for any fusion procedure smoking needs to cease completely. Smoking poses a huge risk to the whether a fusion will take place once the surgery has completed.





DECEMBER 2012

Mary:
I have been taking cortisone shots in sacrum and hips for 2 years now about every 3 to 4 months. How long can I keep doing this or would surgery (Ifuse) be my best choice?

Dr. Patel:
It’s dependent on how successful the injections are at relieving your symptomatic pain. In my opinion if the reduction is greater than 75 percent for up to 12 weeks then continue with this course. However if not then I would consider minimally invasive sacroiliac joint fusion using the IFUSE product.




Virgina:
I have just completed 4 years of steroid injections and radio frequency in the right SI. The last appt about 5 months ago my doctor said the area is degenerated and further treatment would do no good. He said my option was a pain med regimen. I am 81 years old, in good health otherwise. I'm asking an opinion. (I have had 4 fusions upper back years ago, 2 kyphoplasties L1 L3, one vertebraplasty T10 five years ago due to compression fractures. No problems there since.)

Dr. Patel:
If the radiofrequency ablation to the sacroiliac joint has helped for at least 6 months it is worth repeating especially if the relief is significant in your opinion. However if the treatment is not that helpful at relieving your symptomatic pain then I would recommend a diagnostic sacroiliac injection under x-ray guidance to be certain the sacroiliac joint is associated with your current or part of your chief complaint. If positive then I would consider a minimally invasive sacroiliac fusion using the IFUSE product. Please read the article on sacroiliac joint injections written by myself on Spine Health website.




Lyn:
I have had lower back pain for about 20 years since the birth of my daughter. I have also just been diagnosed with Psoriatic Arthritis I have it in my hands, feet, chest, shoulders and I thought it was the cause of my pain in my back. On seeing my consultant yesterday he told me my x-rays were clear of my back so there was no back involvement, so why am I in so much pain? It’s so bad I could cry. I have a Butrans Patch on and take tons of painkillers and I have been on methotrexate but due to developing a rash and blisters I have now got to try Leflunomide. What do you think? I am desperate to know what is wrong.

Dr. Patel:
If your low back pain is lumbosacral in nature and is associated with the birth of your daughter it is possible the sacroiliac joint could be correlated with your pain. I would recommend a diagnostic sacroiliac joint injection under x-ray guidance. If the injection demonstrates a significant change in your typical painful symptoms within the first 1-6 hours then it is reasonable to assume this structure could be causing your pain. Please refer to my article on sacroiliac joint injections on the Spine Health website for further information. If you need a spine specialist to evaluate this I would recommend calling the International Spinal Interventions Society and ask for a physician near your zip code.




Peter:
Long history of L5 S1 disc partial prolapse 6½ yrs ago, exacerbated by open book pelvic fracture (full rupture of pubic symphysis , full rupture Left SI joint). Surgery incl screw through Left SI. Recent damage caused by abductor muscle workout machine in my gym destabilizing the Left SI. 800mg Brufin, chiropractic work, and VERY rarely tramadol for pain mitigation. Pain is now at an intolerable level and debilitating. Chiropractor suggest whole area now too unstable to predict and possibly no cartilage in SI joint. Will see my GP for recommendations but need to know where to look for a management plan. Can surgery be done with a regional block? I DO NOT want a G.A. and I've had surgery under local before.

I am a fit 54 y.o male white collar worker. I have a number of unrelated medical issues typical of my age group.

Dr. Patel:
I would have the facet joint at L5-S1 and the sacroiliac joint evaluated. I would recommend having a diagnostic lumbar medial branch block at L5-S1 and an intra-articular sacroiliac joint injection under x-ray or CT guidance on separate occasions. Then evaluate within the first few hours which symptoms improve and by which percentage. Remember these injections are short acting because they utilize only an anesthetic. If both are the source of your pain based on the traumatic event, the radiofrequency ablation of the L5-S1 facet and IFUSE for the sacroiliac joint would be potential options. However if the diagnostic sacroiliac joint injection is negative, have a diagnostic lateral branch block at S1 S2 and S3 and if positive then consider Bipolar radiofrequency ablation. If the pain relief from the diagnostic injections achieve at least an 80% reduction for a short time depending on the duration of the anesthetic used, these treatments, especially the RFA should provide you at least 6-12 months of relief consistently before needing to be repeated. I would recommend seeing an Interventional spine specialist. If you don’t have one in your area call the International Spine Intervention Society and ask for a physician near your zip code if available.




Atrina:
Last week lifting a basket of clothes onto the bed twisting to dump it out, I felt a pop and almost a snapping sensation in my left side of my lower back. Fell to the floor in great pain and couldn't get up for almost an hour. I took it very easy this last week, honestly I didn't do anything but rest my back. Still one week later, I’m in enormous amount of pain in my lower back on my left side above my hip bone. I’ve been icing it and taking anti inflammatory regularly (ibuprofen). No relief yet, not laying down or in sitting position. What could be the cause of this?? Could it be related to the sacrum or a sciatic pinched nerve? It’s still very swollen and tender.

I am not sure if its related to my stress fractures (L4 &L5) back when I was 16 (I'm 24 now) due to a gymnastics injury (hyper-extended my back as I hit the spring board for vault). I had Dr. Picetti on my side - he braced me for 3 months and helped me regain my complete range of motion with the help of physical therapy. I'm not sure what to think. I have NOT had any back pain since my injury back when i was 16 until now please help!

Dr. Patel:
I would have your left side low back region evaluated by having a diagnostic lumbar medical branch block to anesthetize the L4-5 and/or the L5-S1 zygapophyseal joint in the left side. If positive for an 80 percent reduction of your concordant symptoms with provocative movements on 2 separate occasions I would recommend a radiofrequency ablation of the medial branches at the L4-5 and L5-S1 zygapophyseal joint levels on the left side. This model may help to diagnose and relieve your left side low back pain. Let me know how it works out.




Sandra:
I have pain in my lower back, in my hips and my thighs, as well as pain in my pelvic bone. The pain goes down my legs to my feet sometimes. I cannot sit or stand in one position too long. I'm taking pain meds for some relief, for now. I had an MRI showing a bulging disc, but my Dr. doesn't think that is the cause of pain. It kills to sit or trying to stand up. Walking slowly is ok.

Dr. Patel:
I would have a diagnostic sacroiliac joint under fluoroscopic guidance performed. If the painful symptoms reduce significantly with functional activities within the first 1 to 6 hours, depending on the type of anesthetic used you may consider a therapeutic injection using steroid into the sacroiliac joint. If you fail to progress consider a minimally invasive sacroiliac joint fusion using the IFUSE product from SIBONE.




Alan:
I was in a head on accident between a bus and a fuel truck in Feb. 1973. The rate of speed at impact was approximately 60 miles an hour. There were no seat belts in the bus. My head hit the slide rail of the window and I was knocked out. When I came to, I had a cut on the bridge of my nose. I have no idea of other injuries as no x-rays were ever taken. I was enlisted in the U.S.M.C. and the accident took place in Nam Phong, Thailand. The driver of the truck was killed upon impact. The bus driver had his legs cut off. An officer was thrown out the front windshield and was scalped. Another Marine died of internal injuries. Is it possible for injuries to the spine to be hidden and not to show up until 10 years later?

Dr. Patel:
Sure. The question now is developing a pain model to associate a preexisting finding on the imaging study and your current set of symptoms.




James:
After a rear impact crash a few weeks ago I have been left with terrible back pain. Also, half way down my back (where the pain is) I have quite a large lump/ step out on my spine; it feels like its two bones long. I keep getting a stabbing pain with movement from near the top of my spine down to my right knee. This varies from a twinge to an hour or so long and i just have to hold still until it settles as it really is too painful to move at all. I am waiting for an MRI but I just want to know what’s wrong. Any ideas will be much appreciated. I am only 21 and worried that my back pain will persist throughout life.

Dr. Patel:
I would have a diagnostic sacroiliac joint under fluoroscopic guidance performed. If the painful symptoms reduce significantly with functional activities within the first 1 to 6 hours, depending on the type of anesthetic used you may consider a therapeutic injection using steroid into the sacroiliac joint in conjunction with manual therapy and a pelvic stabilization program. If you fail to progress consider a minimally invasive sacroiliac joint fusion using the IFUSE product from SIBONE.




Myra:
Why would I have extreme pain in the buttocks radiating down my legs to the bottom of my feet?

Dr. Patel:
It could be radicular (nerve root), facetogenic, discogenic, and/or sacroiliac joint in origin. See a specialist.




Robert:
Would you kindly rate cooled radiotherapy, prolotherapy and drug therapy for SI pain? Which would be the preferable approach for a healthy 84 yr. old male?

Dr. Patel:
I would recommend a therapeutic sacroiliac joint injection under x-ray if the diagnostic injection using only anesthetic demonstrated at least an 80% reduction of your concordant symptoms with provocative activities. If you fail to progress, consider a diagnostic lateral branch block at S1, S2, and S3. If positive, then consider RFA of these nerve endings. If you fail to get at least 6 months of satisfactory relief with functional activity and/or the diagnostic lateral branch block is negative, then consider minimally invasive sacroiliac joint fusion using the IFUSE product from SIBONE.




Kim:
When is it time to consider fusing the SI joints and why would this alleviate the pain?

Dr. Patel:
I would consider a minimally invasive sacroiliac joint fusion preferably using the IFUSE product when you have failed steroid injection under x-ray into the sacroiliac joint and physical therapy for the sacroiliac joint for at least 12-16 weeks in duration. Also you would need a diagnostic sacroiliac injection to confirm if the symptoms are associated with the SIJ. If the diagnostic injection cannot be performed properly then 3 out the 5 provocative tests for sacroiliac joint pain would need to be positive on physical exam. The minimally invasive sacroiliac joint helps to reduce pain by reducing motion across the sacroiliac joint.




Pauline:
I have had pain for the past two months in the lower back, which spreads to the hips and buttocks. The muscles in the buttocks are sore to touch. It is easier when resting and awful when I walk. I had an MRI last year and it showed disc degeneration in lower disc, with slight bulge. I cannot take anti-inflammatories as I suffer with my stomach, so only taking Paracetamol. I feel very depressed with this. Hope you can help me.

Dr. Patel:
I would have a diagnostic sacroiliac joint under fluoroscopic guidance performed. If the painful symptoms reduce significantly with functional activities within the first 1 to 6 hours, depending on the type of anesthetic used you may consider a therapeutic injection using steroid into the sacroiliac joint in conjunction with manual therapy and a pelvic stabilization program. If you fail to progress consider a minimally invasive sacroiliac joint fusion using the IFUSE product from SIBONE. Please refer to the sacroiliac joint article I wrote on Spine Health website.




Sharon:
I had a fusion the fusion was taken. I had a back surgery in 1998 and they say my nerves were crushed between the bones. The very next year the bone was on bone had a fusion. Six months later I was in an automobile accident that shifted the fusion and it became very painful. In 2008 I had the fusion removed and pedicle screws were replaced. Sent me home and a couple of days later all of my stitches busted out and they had to rush me back to surgery and redo the surgery over again. Now I have degenerative disc L1-L5 A grade 2. Spondylolisthesus is present at L5. Osteopenia appears consistent Surfication w/multi Luminactomy s,-L2 there is an unleveling with the left ilium inferior Neuroforaminal encroachment is noted at L4 L5

Dr. Patel:
I would recommend seeing an interventional spine specialist if available in your area to ascertain whether your low back and or leg pain is secondary to facetogenic pain from spindyloithesis at L5-S1 and/or possible an L5 nerve root pain syndrome secondary to foraminal stenosis bilaterally at L5-S1.

If both conditions are asymptomatic based on diagnostic evaluations then consider the sacroiliac joint as a potential pain generator. I would have a diagnostic sacroiliac joint under fluoroscopic guidance performed. If the painful symptoms reduce significantly with functional activities within the first 1 to 6 hours, depending on the type of anesthetic used you may consider a therapeutic injection using steroid into the sacroiliac joint in conjunction with manual therapy and a pelvic stabilization program. If you fail to progress consider a minimally invasive sacroiliac joint fusion using the IFUSE product from SI-BONE




G.M. Ranjith:
I am experiencing severe back pain whenever I wake from my bed and also taking deep breaths. I am designer and I used to sit and work in a plastic chair...Help me....

Dr. Patel:
I would recommend seeing an interventional spine specialist if available in your area. If your pain is lumbosacral in nature and the MRI of the lumbar spine is negative for discogenic pathology that could be corroborative with your current set of symptoms, I would have a diagnostic sacroiliac joint under fluoroscopic guidance performed. If the painful symptoms reduce significantly with functional activities within the first 1 to 6 hours, depending on the type of anesthetic used you may consider a therapeutic injection using steroid into the sacroiliac joint in conjunction with manual therapy and a pelvic stabilization program. If you fail to progress consider a minimally invasive sacroiliac joint fusion using the IFUSE product from SI-BONE.




Kelly:
I have had an MRI scan and it shows severe disk height loss in 4 discs and a bulging disk which is hitting my nerve root. I am in terrible pain mostly at night when I lose feeling in both legs and I wet myself the other night. I'm only 38 and I get so scared my feeling won't come back. My husband has to turn me over in the night as my back just locks. Can you please advise me?

Dr. Patel:
Your back pain could be related to the facet joint secondary to disc height collapse. The leg numbness and or pain could be referred from the facet joint or nerve root in nature. I would recommend seeing an interventional spine specialist in your area if available to delineate whether this is the case and ascertain whether treatments like radiofrequency ablation of selective nerve root injections would be a useful adjunct with physical rehabilitation principals in managing your painful symptoms.




Sandra:
I am 43, diagnosed with Failed back surgery syndrome/post laminectomy syndrome. I was scheduled to have open, traditional right-sided sacroiliac joint fusion surgery (with bone grafting) on January 10, 2013 at Mayo Clinic's St. Mary's Hospital. The Orthopedic surgeon cancelled my surgery yesterday because I had sent a message to his Orthopedic Service staff that I had been experiencing left hip pain secondary (I believe to my femoro-acetabular impingement, pincer deformity with osteoarthritic synovial pitting) which radiates to my Left SI joint. Or my Left hip pain could be secondary to my compensation for the Rt. SI joint dysfunction. WHY is Left hip pain a contraindication for proceeding with the Rt. SI joint fusion surgery? I know that I was told that I would have to be non-weight bearing, toe touch weight bearing for 3 months had the Rt. SI joint fusion surgery taken place. I feel hopeless now.

Dr. Patel:
If you’re having significant groin pain on the left side I would agree it could be impingement. I would recommend a one time therapeutic injection into the left hip using steroid preparation under x-ray guidance. If this helps to alleviate the pain then consider a minimally invasive sacroiliac joint fusion using the IFUSE from SIBONE for the right SIJ pain. Yes, you will still have to be non-weightbearing but only for a few weeks and it is less aggressive. Please call the number on the SIBONE website and ask to be referred to a surgeon who is trained using this product.





NOVEMBER 2012

Teresa:
I had an osteochondroma removed from my right SI joint in 2001. They removed half of my joint and left it like that. Ever since then I have lived with chronic pain. I had two disc replacements L4, L5 - S1 in ‘05 thinking this was the cause of the pain. Then in 2010 I had a procedure done where a needle with pain medicine was directly put into my SI joint using a CT scan. The effect lasted 2 hours (no pain). No one at the time would touch me (at OHSU in Portland) now I have heard there is SI joint fusion. Is this a possibility for me? Is there such a thing as SI reconstruction because I've searched for years and can't find someone who does reconstruction so I now found this and I am wondering if this might benefit me. I am 50 years old and have been on disability since 2001. This is not how I envisioned my life. Taking morphine 3 times a day. The pain can be so horrendous. Thank you for any guidance you might give.

Dr. Patel:
Sure. You could be suffering from SIJ pain from adjacent segmental pain stress from the L5-S1 fusion and from the osteochondroma that was removed from the SIJ. If the injection under CT utilized only anesthetic into the SIJ and this demonstrated significant relief for approximately 2 hours then it’s more reasonable to assume the SIJ could be the source of your current set of symptoms. Please read my article on spine health for SIJ injections. However I would see a surgeon that performs the IFUSE device.




Marcus:
I have had two back surgeries. I had a multi-level discectomy from L3-S1 and then I had a lumbar fusion from L3-S1 with pedicle rods and screws . I am still in constant pain. Do you think the metal hardware may be loose or causing my pain?

Dr. Patel:
Some surgeons feel that hardware could be the source and some do not. Incomplete fusion is a cause of concern. However if you are having constant pain along the waistline or below that is the worst area then the sacroiliac joint (SIJ) could be the source of the pain. I would see interventional spine specialists that could perform a diagnostic sacroiliac joint injection under x-ray or CT guidance. Please refer to my article on Spine-health for sacroiliac joint injections. If positive and you have exhausted conservative treatment options then I would consider a minimally invasive sacroiliac joint fusion (IFUSE).




Rebecca:
I had spinal fusion with discectomy (L5, s1, s2) and hardware placement in 2009, and just had my hardware removed 3 wks ago. I’m in severe pain. How can I get relief and how come it’s so hard to get pain medicine? What can I do? I hurt so bad, how can I get somebody to help me?

Dr. Patel:
I am not sure why your specialists are not providing you with pain medicine. However, if you are fused along the lumbar spine down to L5-S1 then I would consider having the sacroiliac joint evaluated. Please refer to my article on Spine-health for sacroiliac joint injections. If positive and you have exhausted conservative measures for this diagnosis then I would consider a minimally invasive sacroiliac joint fusion.




Cheryl:
What percent of patients require the sacro stabilization done bilaterally? I am surprised that only one side is done.

Dr. Patel:
Actually unilateral is more common than bilaterally. There exists a low percentage of cases done bilaterally and/or both sides done at different times. This data is based on the total number of IFUSE cases performed to date.




Angela:
I have degeneration of the l3 l4 l5 & S1. I’ve had endless lumber injections, none with any major long term relief. I am on mst, oramorph, gabapentin, diazepam, amitriptyline and more. In June 2010 I was in a coma for 7 days with pneumonia and 2 other times ICU admissions with fluid-full lungs and respiratory failure. After scans, x-rays and many more tests they think it’s my medication. My last injection was a sacroiliac one and I had complete pain relief. My surgeon didn’t think my relief was long enough. I know his putting anesthetic in my joint that day took my pain away. I’m still on all my meds and having respiratory problems again. They have agreed to do it as an emergency next week for the same thing, I think. When pregnant I got hip dysplasia really bad and had to be fitted with a brace that still helps me to this day. I’ve done so much research and everything seems to come back to my SI joint. Now my right one is the same and I can’t stand on either leg on its own without nearly crying with pain. I cannot lie on either side to sleep or my hip feels like its snapped when I wake up. It’s a 10 on the pain scale. My walking is getting really bad and I can hardly do it. I have to use my wheelchair or scooter to go out. My hips keep locking in mid-step or just standing too long. Major problem is I keep having really bad falls because of this. Can you tell me what’s making them lock all the time? I’ve now injured my T7 and need to see a spinal surgeon. I don’t understand why. I’ve not seen a hip specialist -- would they know more or why he cannot fix my sacroiliac joint? I have just discovered your site and never heard of it used. I do know they are under pressure with government cuts. They have even had to stop my acupuncture because of cutbacks and he knew that it really helped me and suggests paying for it. Please could you help me to understand all this? My leg locked again yesterday and I had a bad fall between my French door and my decking. My daughter is 4 and raised my alarm for help. I cannot carry on any more. I don’t know what to say to them next.

Dr. Patel:
Since you are fused down to L5-S1 I would have a diagnostic sacroiliac joint injection under x-ray or CT guidance to evaluate how much improved your symptoms feel with functional activity within the first 3 to 6 hours. Please refer to my article on sacroiliac joint injection on the Spine-health website. If positive then I would consider minimally invasive sacroiliac joint fusion using IFUSE.




Amar:
Please help translate this: “there is postero-central bulge at L4-L5 IV disc causing narrowing of B/L lateral recess.”

Dr. Patel:
The concern is whether you are developing severe postero-lateral buttock, lateral thigh and lateral calf pain with standing/walking vs sitting. If yes then it is possible the disc bulge which sits in the lateral recess at L4-5 could irritate the L5 nerve root. However if you are noticing more leg pain down the anterior thigh and shin then it could be the L4 nerve from the disc bulge at L4-5. However if you are having minimal leg pain and more back pain then the disc bulge could be the source and not the narrowing of the lateral recess from the disc bulge. Hope this helps.




Kimberlee:
Hi, I am 45 yrs old and I drive a school bus. Last February I was in an accident while driving the bus. The bus was at a stop and the truck that hit me was speeding and hit just below the driver window. I was looking down at the time to check my route sheet and the next thing that happened was my left wrist and thumb was stinging and bruised. The mechanic said that the steering column was shifted to the far right. They said I was lucky that my wrist wasn’t broken. Of course I had some pain in my neck, left shoulder, collar bone, down the left arm and upper and lower back, mostly on left side. As time has passed symptoms are getting worse, headaches, burning pain, neck pain, numbness. I had an MRI that shows a bone spur. I have never had anything wrong with my neck or my back before this. I have gone through PT with a lot of traction and have no relief from my symptoms. Could this bone spur have gradually grown (that’s why the symptoms are getting worse) in the last 9 to 10 months?

Dr. Patel:
Most likely the bone spur is pre-existing. However if this bone spur is causing foraminal stenosis which could corroborate your upper limb pain, as seen on an MRI of the cervical spine, then this pre-existing structure could be aggravated from the MVA.




Yvette:
Dear Dr.: 4 days ago my pmdr performed rfa left side L3-S1. Two weeks prior he did the right side. The first one went fine. However, I am 4 days out since left side was done and I can't bear weight on my left side at all. When I try I scream out in pain. I can't sit for but a few minutes and I can't lay on that side either. I also have two stage knots come up on my hip as well. My Dr went on vacation so I can't ask him. When my husband helps me to the bathroom it feels like my hip or pelvis its locked. I'm in hell -- please help me.

Dr. Patel:
It is normal to have increased pain after an RFA especially within 3-4 weeks. Maximal relief from the procedure is typically achieved by the 10-12 week and should be at that level for at least 6 months.




June:
I had an SI joint injection Aug. 27, 2012 on left side. It helped. How long can I expect relief? Also, after shot I have been experiencing low back burning ache from rib cage to hip bones straight across and sitting is my only relief. I have degenerative disc disease and have had fusion & rods with 3 surgeries.

Dr. Patel:
If the therapeutic SIJ injection lasted for at least 6 weeks, get repeated. However if you are not satisfied with the long term results consider a minimally invasive sacroiliac joint fusion using the IFUSE product.




Marie:
Some surgeons have a physical therapist adjust the SI to its proper position prior to surgery. Others say that the SI can only move 3mm, so this is unnecessary. Since I have periods of time with no pain and then sudden onset of pain, I am wondering if the idea of adjusting the SI is reasonable. I believe I can also put a bit of traction on the SI joint when I am hurting and decrease the pain.

Second question: Did you perform other SI surgeries, fusions or screws, before using the I Fuse system??

Dr. Patel:
Manipulation for SIJ pain is effective and useful. I feel if patients have responded well with manipulation it’s but short-lived I am okay with manipulation prior to surgery. I would only recommend the minimally invasive surgery using the IFUSE device as the only means of stabilizing the SIJ.




Hani:
Sometimes when I try to massage my head the skull hurts just from my touching it. It is only some parts of my head so I was wondering where that pain is coming from.

Dr. Patel:
Could be from the C2-3 zygapophyseal joint, greater or lesser occipital nerves, tension head pain from tight suboccipital muscles. If the pain is not located at the base of skull posteriorly then see a headache specialist to see if you have an extraspinal disorder causing this set of symptoms.




Christine:
I have been diagnosed with severe osteoarthritis in the sacroiliac/lumbar spine, with stenosis and degeneration of some vertebrae in lower back and cervical spine. I am in constant pain, especially after being on my feet for periods longer than 15 minutes. It feels like rusty gears being crunched against each other and I can hardly walk. I am on Oxycontin 30mg morning, 20mg 4pm with 5 to10mg of endone. I also take panadeine forte in between, which does nothing. I'm also on Gabapentin for phantom limb pain due to amputation of lower right leg. I have spinal scoliosis also. Pain is mainly on my right side lumbar/sacroiliac area and hip. My question is "Would steroid injection be of any help?”

Dr. Patel:
I think a spine specialist need to ascertain how much of the majority pain is emanating from the pelvis in the form of sacroiliac joint pain as opposed to a lumbar radiculopathy from the spinal stenosis. This should be the starting point because you are on too much prescription opiods for chronic pain management.




Mike:
I have been suffering from low back pain for four years and SI problems have been suggested. PT helped a little but did not last. Can SI joint pain cause pain to go up into your back around the ribs as well as down the leg? Also, cold wet weather really increases my pain. My whole back now feels like someone has beat me up.

Dr. Patel:
I would have a diagnostic sacroiliac joint injection under x-ray or CT guidance and evaluate which symptoms improve within the first 3 to 6 hours with functional activities and which ones do not improve. Please refer to my article on sacroiliac joint injections. Start from here. Then you can assess if this structure is correlated with all your symptoms or just part of it.




Cindy:
I had spinal fusion 7years ago in my neck and I’m in constant pain. Is artificial disc replacement even possible after a fusion? Thanks for any help I can get on this question.

Dr. Patel:
At the level of your current surgery I would think “no” to the artificial disc especially if there is a complete fusion. I would have the facet joints evaluated above and/or below the spinal fusion using diagnostic cervical medial branch blocks at those levels to see if the neck and/or associated head pain improved by at least 80 percent for a few hours with functional activity. If positive on 2 separate occasions then I would consider radiofrequency ablation of those medial branches.




Ong:
I've encountered 3 occasions this year where there's no feeling in both my legs all of a sudden and I fell onto the ground, but both legs regain their feeling and strength fast without me having to do anything. I just sat on the ground until I could stand up again.

About 9 years ago, my lower back hurt very badly one morning and I struggled to a certified Chinese acupuncture doctor, just because she was nearest. It recovered over 9 sessions of acupuncture, thereafter it was lower back pain now and then. Once, it was so bad that even standing still was a torture. Now my upper body would shiver if I carry heavy things.

Dr. Patel:
I would have an MRI of the lumbar spine order to see if you suffer from moderate to severe spinal stenosis that could corroborate with this weakness. I would also have an EMG/NCS study to see if you suffer from active nerve damage in a particular nerve root distribution. If the MRI and EMG/NCS are equivocal then they need to evaluate the cervical and thoracic spine to ensure the spinal cord is not affected. If this is equivocal then the leg weakness could be pain induced.




John:
I have no disc at L5/S1. I had back surgery at Frenchay Hospital Bristol in 1996. After a further MRI Scan in 2009, I spoke to one of the consultants on the Disc/ Vertebra design team, I was informed that extensive tests had been done in respect to spinal fusion and it was a total waste of time. Only half the 200 patients were operated on, the placebo effect, all complained of the same pain after the supposed operations. Further to this, disc replacement surgery is available. While talking to the Clinical Director (Mr I K Pople) he explained that the main cause of the pain was due to nerve damage. Even if I had an operation, I would be in further pain due to another operation, which would cause more nerve damage, given that it would take a further 10 years before anything could be done to repair nerve damage. I find disc replacement would not take away the pain, why is this information not explained?

I was a Design Engineer and explained that when I had looked at some of the designs, I could have done better myself. I suggested a disc with the same material properties as a human disc, a high density rubber disc impregnated with fibre optics, as a neural pathway, transmitter/reciever above and below the damaged nerve and transmitting normal signals as per a normal person moving all directions/weight compensation via micro pressure sensor giro chip IC to act as a neural pathway.

Dr. Patel:
I am not sure why this information is not explained. If you are having a severe low back pain along the waistline, worst with standing and or walking better with sitting, then obtain a diagnostic lumbar medial branch block at L5-S1 and see how low the pain feels within the first few hours before it wears off. If significant on 2 separate occasions then consider radiofrequency ablation at this level. It is possible the shorted disc height is placing more stress on zygapophyseal joints at L5-S1. However if you have had a spinal fusion at L5-S1 consider the sacroiliac joint because of adjacent segmental stress to the sacroiliac joint. Read my article on Spine-health on sacroiliac joint injections. If positive then consider IFUSE which is minimally invasive sacroiliac joint fusion.




Elise:
I have been dealing with chronic SI and lower back pain for ten months now. Numerous tests but nothing found that is significant enough to be causing the pain I am having. Have had numerous injections of SI joints and facet joint, RFA, and continuing physical therapy. Improved from how I was five months ago, but still suffering every day. Have found and met with a surgeon who does the ifuse. Just wanting more information before I schedule surgery.

Dr. Patel:
Please go the SI BONE’s education center - http://www.spine-health.com/education-centers/sacroiliac-joint-disorders/patients. There is a section for patients. It should have all the information you need.





OCTOBER 2012

Karen:
I had TLIF procedure at L4/L5 9 days ago. The first week was great. I have had some nerve pain but not unbearable. Two days ago the original nerve pain that I had prior to the surgery has returned. Is this normal or is it an indication that the surgery was not successful? I am following my surgeon's instructions to the letter. Thank you for any insight you can provide.

Dr. Patel:
If the main chief complaint for the surgery was severe radicular pain and your pain from the buttock down the leg the pain has improved, this was the purpose of the surgery. However, if you are having pain along your waistline and that pain is most severe going from sit to stand or standing/walking then it is possible the TLIF is applying stress to the L5-S1 segment of the spine or even the sacroiliac joint. However, it is too early to tell. Give it 3 months and note which symptoms are tolerable and which ones are not.




Nancy:
360 degree two level interbody fusion at L4-5/ L5S1 was done a year and a half ago. I did well for about 5 to 6 months and after that realized my pain and stiffness was not going to allow me to be returning to work anytime soon. I applied for SS disability. Point is I got steadily worse as far as stiffness and continued pain. My fusion levels look great, I don't. Several health care professionals have unfortunately treated me as "a drug seeker". Finally I had an MRI which was ok, and it was noted that with my bony prominences, the area that I could point to where pain seemed to be originating was the sacroiliac right where the screws are at the tops of my posterior incisions. I will now have that screw area blocked, and if I receive pain relief... looks like I will be a candidate for hardware removal. I've felt the hardware since the surgery but my symptoms now are debilitating, and pain medication barely takes the edge off. How much easier is it to remove hardware than the what I call major surgery I had before, and will it be removed from the two incisions on my back or through the front. I believe the front approach was to remove the two discs. My entire life has been turned upside down, and it's been a complete nightmare. I had gained 50 lbs before surgery and now I'm down to my normal 125. Shouldn't I feel much better with the hardware out? The fusions did great. Does this mean the sacroiliac joint is receiving too much pressure from the bony prominences that were not bony when I was seen for surgery? How long does removal of hardware take? My entire surgery was around 3/4 hrs.

Dr. Patel:
Yes. It is possible that the sacroiliac joint could be the source of your painful symptoms. The L5-S1 interbody fusion could be applying adjacent segmental stress to the SIJ joint. A diagnostic sacroiliac joint injection would be a useful step to ascertain whether your current set of symptoms could be emanating from this structure. Please read my article on sacroiliac joint injection prior to seeing a specialist about this possible pain generator.




Qaiser:
I'm a 33yr old male, 186cm tall, and my current body weight is 93kg. I've been experiencing lower back pain since I was 19yrs of age; my body-weight back then was 77kg.

To begin, the pain was localized directly over my right SI joint, and radiated to my right hipbone. The pain is best described as a deep & dull ache. Since then, it has spread over to my LHS SI joint as well as my lumbar vertebrae, especially between L5-S1.

I've seen various specialists and have had all sorts of scans carried out, with the conclusion being that it's just a case of 'wear and tear' of these respective areas. I've carried out various exercises and have received lots of physiotherapy and chiropractic sessions. The most effective treatment to date was a series of epidural injections around my right SI joint area and in the disk between L5-S1.

Other symptoms include:

  1. Lack of hip mobility, especially in the right side hip
  2. Tight hamstrings, Hip-Flexors, Gluteus, and Lower-Back muscles, with the rhs significantly tighter than the Lhs.
  3. A small sized lump sitting directly over my rhs SI joint. Perhaps calcification?
  4. I've been told that my lumber vertebrae are 'partially fused'.
  5. Spinal lordosis.
  6. Imbalance whilst standing / walking such as: natural leaning into my Lhs hip, taking larger strides with my left leg whilst walking.

I would greatly appreciate your input and advice with regards to my condition, and whether I would benefit from SI fusion. Please reply soon and I look forward to your response.

Dr. Patel:
Typically the pain that you’re having could be emanating from the sacroiliac joint, the facet joint at L5-S1 or the disc at L5-S1. It would be interesting to see how much your back pain with standing and walking is correlated with the facet joint at L5-S1. Typically a diagnostic lumbar medial branch block is useful where 0.3 to 0.5 ml of anesthetic is placed at the medial branches to anesthetize the L5-S1 facet joint under x-ray guidance. If you notice a significant change to your low back and hip pain within the first 3-6 hours with standing and walking then I would consider radiofrequency ablation of those medial branches and that should work well for those symptoms. However, if this diagnostic injection is negative, then I would consider a diagnostic sacroiliac joint injection under x-ray guidance. If positive then consider steroid medicine placed into the joint with pelvic stabilization program and manipulation along with strengthening of the lumbosacral muscles and hamstrings. However, if this does not work consider a minimally invasive SIJ fusion. However, if the diagnostic sacroiliac joint injection is negative then it is most likely discogenic and transforaminal epidural steroid injections in conjunction with lumbar traction and improving your hamstring flexibility while lying on your back is your best option.




Joseph:
Dear Doctor, I have my Microdiscectomy on September, 22nd 2012 for my lower back L5-S1. I would like to seek your kind advice what I should do and should NOT do after the surgery.

Dr. Patel:
Your best option is to ask your surgeon. However, I would only have a microdiscectomy at L5-S1 if you were only having severe leg pain.




Magaji:
I play attacking mid-field. I had beaten two defenders while trying to attack my opponent but I was still under pressure by two defenders from both my left and right side. In the process of trying to outrun them they used a combined force to pull me down. Ten minutes later I started feeling pain but I didn't stop playing. I continued but the next shot I took was my last shot of the day with an excruciating pain and I couldn't walk and needed my teammates to walk me to the car. Ever since then I kept on struggling with a severe lower back pain that sometimes doesn't allow me to walk properly, sit properly or even move around while laying on my bed. I have tried x-ray but the doc said there was nothing wrong with my lower back, I have been prescribed several drugs but none seem to cure my problem. It has been a problem for close to six months without hope of ever going back to what I hope to do in the nearest future and that's becoming a professional soccer player. Please! I need help

Dr. Patel:
If you are having pain along your waistline and hip and it hasn’t resolved on its own, it is possible the sacroiliac joint is the source the disc at L5-S1 or the facet joint at L5-S1. I would see a physical therapist and see if manual medicine will help alleviate the symptoms in conjunction with stretching or lumbar traction. If this does not improve symptoms after 6 visits get an MRI of the lumbar spine.




Wendy:
I had spinal fusion in 2006 and recently had knee replacement surgery in July but my lower back still aches most days. My massage therapist says it is the sacroiliac joint on my left side. My job involves a lot of repetitive lifting and I love my job but I can't seem to get an answer from my doctor except anti-inflammatory which aren't helping. What alternative do I have? I can't bear not working, I’m only 53.

Dr. Patel:
What level was the spinal fusion? If is was at L5-S1 yes it is possible that SI joint could be source of the pain because of stress being place from the interbody fusion on the segment below which is the sacroiliac joint (SIJ). Typically pelvic stabilization exercise and hamstring strengthening and stretching does not help, get a diagnostic injection under x-ray guidance. Read my article on sacroiliac joint injections on Spine-Health.com. If positive on 2 separate occasions, then consider a minimally invasive sacroiliac joint fusion.




Mary:
I have been having pain in my tailbone for a number of months now. I had a fusion on 1-12-11 of the L-3/L-4, L-4/L-5, also a L-5/S-1 laminectomy/discectomy in 1991. Not long after the fusion, I started getting severe pain on my left side, lower back, buttock, back of left leg. I am unable to stand very long or sit, walk very far and to sleep is very difficult as I have to lay flat on my stomach and my legs have to be perfectly straight to ease the pain in and around my tailbone and when I stand up from laying down, it feels as if my spine is going to fall to my feet. I am unable to find any doctor in my area that can find figure out what is causing this. Thank you.

Dr. Patel:
If your fusion extends only to L4-5 it is possible the L5-S1 facet joint could be the source of pain. However if the fusion has extended to L5-S1 then have the sacroiliac joint evaluate as the potential pain generator. Get a diagnostic sacroiliac joint injection under x-ray guidance. Read my article on sacroiliac joint injections on Spine Health. If positive on 2 separate occasions, then consider a minimally invasive sacroiliac joint fusion.




Kim:
I have been having problems with my hips and back for years after my daughter who is now 22 was born. I have seen a chiropractor and get some relief. The problem that I can’t explain to the doctor or therapist is that I cannot run. When I try to run my left hip and back act like they are stuck or don’t know what to do and I get pain down my leg. I can run on treadmills and in place but not run on the road or play basketball with my kids. How would you tell me to talk to the chiropractor or doctor about this or do you have any ideas of what is causing it? Is this a chiropractor or is there a different kind of doctor I should see?

Dr. Patel:
See a specialist that performs diagnostic interventional spine injections under x-ray. I would find someone who is a member of International Spine Intervention Society. Call them and ask for someone in your area. I would have the sacroiliac joint evaluated to see if this is correlated with your severe symptoms. Post partum pain generators could be the sacroiliac joint or even the disc at L5-S1. An MRI of the Lumbar spine may be in order if conventional physical therapy has not helped to alleviate the symptoms significantly. Please read my 2 articles on sacroiliac joint. See if your symptoms are similar.




Jennifer:
Two years ago I had emergency surgery on my back to remove L4 L5 discs which had come out and embedded deep down in my nervous system, and just the other week I had another scan on my lower back and confirmed arthritis and nearly all my Ls, Ts and s discs have prolapsed and one is touching my nervous system. I am only 39 and I didn’t really understand what my doctor was saying so can anyone help me understand what it means and what can happen to my back in the future?

Dr. Patel:
No one can predict what symptoms you will have endured as a result of the back surgery. If you’re not in pain that is great. These prolapsed discs can cause a plethora of symptoms such as severe leg pain, paralysis of the legs, loss of bowel or bladder control. However, the findings mean nothing if you have no symptoms. However, if you have symptoms that are concerning inform your physician.




Wilfredo:
Hip joint (is it the same as sacroiliac joint?) MRI has been done on me last October 12, 2012 and the result is a slight swelling of tissues just lateral to the trochanteric segment of the left femur. The femoral heads and acetabula are of normal shape and femoral heads are well covered by acetabular margins. The joint spaces are of normal width. My symptoms seem to be sacroiliac in origin: numb left upper thigh and radiating pain up to shoulder. I slipped on a mossy footpath, cemented last July, and landed on my left hip. One Ortho surgeon recommends MRI of lumbar stenosis while the other recommends nothing at all. I have undergone L4-L5 discectomy for herniated disc which was already broken per information by the Ortho surgeon. Surgery was done last Feb 07, 2007. Cause of herniated disc is lifting of heavy colleagues in a lifting game of men being inserted in a hole in a manila paper for team building purposes in my former project's office. There was a crack at the back I audibly heard and felt since then sweating is differently dense. Team building lifting was done last April of 2004.

Dr. Patel:
It is possible the fall could have stressed the sacroiliac joint or the trochanteric bursa. I would recommend a diagnostic sacroiliac joint injection under x-ray guidance. If positive for a significant reduction of your concordant symptoms with provocative activities then I would consider steroid medication into the sacroiliac joint in conjunction with a pelvic stabilization program. If you demonstrate no improvement then consider a minimally invasive sacroiliac joint fusion. However, if the diagnostic sacroiliac joint injection is negative consider a therapeutic trochanteric bursa injection under x-ray guidance. Please read my article on sacroiliac joint injections on spine health.




Dawna:
I am 47 and have had back pain for 15 years. I am 50 lbs overweight which I know does not help. My pain is very low in the back (tailbone area) and mostly on the right side. I have been to my local doctor and she said it is just old age and that it is my SI joint. I can feel the pain constantly (manageable) but at night is when it hurts the worse and wakes me up. Also, walking for any length of time or standing for any length of time makes it really start to hurt. Stabbing pain on the right side where the SI joint is located. What should my next step be?

Dr. Patel:
It is possible the L5-S1 facet joint or the sacroiliac joint on the right could be the source of the pain. It would be interesting to see how much your back pain with standing and walking is correlated with the facet joint at L5-S1. Typically a diagnostic lumbar medial branch block is useful where 0.3 to 0.5 ml of anesthetic is placed at the medial branches to anesthetize the L5-S1 facet joint under x-ray guidance. If you notice a significant change to your low back and hip pain within the first 3-6 hours with standing and walking then I would consider radiofrequency ablation of those medial branches and that should work well for those symptoms. However if this diagnostic injection is negative, then I would consider a diagnostic sacroiliac joint injection under xray guidance. If positive then consider steroid medicine placed into the joint with pelvic stabilization program and manipulation along with strengthening of the lumbosacral muscles and hamstrings. However if this does not work consider a minimally invasive SIJ fusion.




Merie:
I have been referred for neurosurgical treatment of SI joint chronic subluxation (1-1/2 years since injury). I would like to know about the recovery process, how long non-weight bearing, how long without sitting, what kind of assistance I will need after surgery, etc.

Dr. Patel:
Recovery process varies between 3 weeks to 3 months. Patients are typically non-weight bearing for 3 to 6 weeks. You will be on crutches or a standing walker for 3 to 6 weeks. You will need assistance with basic activities of daily living (ADLS) and instrumental ADLS during this time. Then once you are full weight bearing you will start a physical therapy program to help strengthen the hip abductors and adductors and other supporting muscles of the sacroiliac joint.




Sue:
I am going to have iFuse surgery in October, and will I be able to travel by plane Nov. 15th.

Also is there a surgeon in Knoxville, TN trained to do iFuse surgery

Dr. Patel:
This is up to the surgeon. Contact SI-BONE for a referral for a surgeon in Knoxville.


SEPTEMBER 2012

Dee:
How is diagnosis of subluxed SI Joint determined?

Dr. Patel:
It is difficult to determine. When a manual therapist performs a manual medicine technique on your sacroiliac joint and you hear a “clunk” with pain relief within 1-2 days then it reasonable to assume that you may have a sacroiliac joint dysfunction. However, a subluxed sacroiliac joint is difficult to diagnose. Radiographic imaging and/or physical exam techniques are not sensitive enough to diagnose a subluxed sacroiliac joint.




Janet:
I was diagnosis PIRIFORMIS SYNDROME but after injections of corticosteroids I am still in pain. With SI Joint disease, would one have pain after bowel movements? Can prolonged sitting cause pain?

Dr. Patel:
It is possible. If you are concerned that the sacroiliac joint could be the source of the pain have a diagnostic sacroiliac injection performed under xray guidance. Please refer to my sacroiliac joint injection article for parameters of the diagnostic sacroiliac joint injection. If the diagnostic sacroiliac injection is negative then it could be the L5-S1 intervertebral disc as the source of the symptoms. Piriformis syndrome is an uncommon diagnosis and a diagnosis of exclusion.




Lorraine:
What are the most common symptoms if SI joint issues? Right now I am experiencing severe pain near that area as well as hip, side of hip, pririformis spasming, and some spasming down the leg. The pain is only getting worse after PT and chiropractic treatment. I will have very occasional temporary relief from chiropractic traction, but nothing long lasting at all. The pelvic instability and pain has gotten so bad that it has affected my upper back as well.

Dr. Patel:
Patients will typically have pain along the lumbosacral region (belt line) or below. The pain gets worse sitting, standing and walking on the affected side and is relieved with laying on the unaffected side. You can have referred pain into the buttock, thigh and even calf. A diagnostic sacroiliac injection can help to corroborate your painful symptoms. Please refer to my sacroiliac joint injection article in Spine Health.




Ian:
I had an anterior LS-S1 spinal fusion 12 weeks ago due to a ruptured disc. I woke up from the surgery with a complete new type of pain which is a deep/sharp boney pain. I often get pain in both legs, burning sensations in both legs and testicle pain. I find it hard to lie down and turn over in bed as I feel as if something is moving deep inside my sacrum. The pain is more central than to any particular side and is very different from what I was getting before.

I have 2 screws in the sacrum and 2 into the sacrum. I sometimes feel as if the screws are moving, but the doctor says they are not. I also had facet blocks yesterday, which did nothing.

What do you think could be causing the problem?

Dr. Patel:
It is possible that the sacroiliac joint could be the source of painful symptoms from adjacent stress created from the L5-S1 interbody fusion. A diagnostic sacroiliac joint injection under xray guidance can become useful tool to help corroborate your painful symptoms. Please refer to my sacroiliac joint injection article for parameters of the diagnostic sacroiliac joint injection. Hope this helps




Lisa:
What effects does weather have on my severe back pain?

Dr. Patel:
Precipitation can increase low back pain. Falling temperatures can cause constriction of blood vessels and the ability of oxygen to get to the tissue gets impaired and as a result inflammatory mediators can be released causing pain.




Jassim:
I have been suffering from lower back pain for quite some time. Lately I have been injected with a spinal injection that worked for only one week. Should I receive more injections of this nature or continue to take relaxation pills, pain relievers or what else? I am 76 years old. Generally I am ok but my right and sometimes left legs keep jumping while I am sleep. As a result of this my wife now sleeps elsewhere.

Dr. Patel:
Are you aware of what type of spinal injection you received? What is the exact interpretation of your MRI of the lumbar spine if you had one. Thanks




Shruti:
I am suffering from lower back pain. I showed to the doctor, he said there is some disc bulge in the lower part of my back and gave me some medicines. He also gave me an Epidural Steroid Injection. Please can you suggest a few exercises or medications that will make it better. I am 24 (will be 25 in nov). How is this happening to me when I’m so young?

Dr. Patel:
I would recommend improving hamstring flexibility. However, perform these stretches when laying on your back. If you are lifting weights use a lifting belt for stability. Utilize NSAIDS for muscle soreness before bedtime or first thing in the morning. Lumbar traction with a physical therapist may provide some benefit for the low back symptoms or even an inversion table. Hope this helps.




Remilekun:
I had a surgery on my left leg like 3 months back. My consultant told me to start putting my weight on it a week ago and suddenly I noticed a swelling on that leg, the part I had surgery on, the area where the plate was fixed. I need to know if it is serious because it hurts a bit and is hot.

Dr. Patel:
I would discuss your symptoms with your surgeon and get reassurance that the symptoms you’re feeling are of no concern.




Jenni:
In 1979 I had a spinal fusion to correct Scoliosis. Bone was harvested from my SI joint. Now, 30+ years later, I'm in horrifying levels of pain in that location. To complicate things, I had a 2nd spinal fusion 3-years ago. I have Ehlers-Danlos Syndrome, Fibromyalgia, and the added joy of Degenerative Disc Disease. I've been walking with a cane and walker for years now, but until recently I'd been able to get around the house unaided, so long as it was in short bursts. That's no longer possible. I'm unable to bear weight unaided, even getting off the couch makes me scream in agony. Please tell me there's something that can be done? I'd prefer to not have to endure another surgery; the last one was brutally painful and extremely traumatic. Is there any advice you can give?

Dr. Patel:
Scoliosis and the fusion could be creating stress to the sacroiliac joint. An X-ray guided injection into the sacroiliac joint could be useful to ascertain whether your symptoms are emanating from this structure. If positive on 2 separate occasions, steroid injections into the sacroiliac joint, manual medicine, pelvic stabilization program, sacroiliac joint belt are all good options in conjunction with NSAIDS. However, if these less aggressive options do not provide sustainable relief to your satisfaction then I would consider a minimally invasive sacroiliac joint fusion. Please refer to my article on sacroiliac joint injections for reference. Hope this helps.




John:
Hello, I have been in excruciating pain for years now; I have unbelievable pain above my L-2 all the way to S-1 and outside my tail bone. I take a lot of Oxycodone which helps a bit. I had an Axialif on S-1 and Xlif procedure on L-3 L-4 and L-4 L-5. I was told I would be about 85% and be able to do full contact sports but I can barely move right now. I have been complaining for an SI Joint injection for over 2 years, especially after the surgery. The surgeon ordered the PM to give me a SI Joint Injection because I had waistband and hip pain. Also the surgeon told me I had arthritis up and down my spine and showed me it looked like water on the vertebra on the xray.

I am at a loss right now because the Workman’s comp lawyer tells me to ask the PM so I ask the PM and he writes up the order for an injection in his report each month and my work insurance CNA denies it through Corvel and their team of Doctors.

I was told by the Surgeon that I would probably need at least a couple of the SI joint injections a year; did I hear that wrong from him? Anyway I am on the verge of giving up I can't take much more pain from my upper back and lower back it’s just not right for them to keep me in this much pain and just keep up what they have been doing denying me pain relief and the ability to get up and just go for a walk. Everybody keeps telling meto just get down to the gym, just to go for a walk, float in the pool; they say “come on you just have to do it man”. Well it’s not that simple when you can't even make it out of the house; it’s just not right.

Please give me some advice so I won't go crazy. I am seriously thinking about calling another lawyer for the Workman’s Comp Lawyer not helping me and the Surgeon discharging me 6 months after a 3 level fusion surgery. Also the doctor told me it was a 5 and a half hour surgery while my wife said it took approximately 8 hours. I asked him and he said nothing. Also I have had major internal issues that are still following me now a bit better but still have problems with the digestive track. Let me know if you can help me I just need some relief.

Dr. Patel:
If your fusion has extended down to L4-5, and you are having pain along the waist line or even a little lower, the 2 logical structures that could be corroborative with your this pain could L5-S1 facet joint pain syndrome or sacroiliac joint pain syndrome. The way to corroborate this pain with the L5-S1 facet joint would be to have a diagnostic lumbar medial branch block to anesthetize the L4 and L5 medial branches where no more than 0.5 cc of anesthetic should be injected at each level evaluating your functional pain being reduced where the pain intensity is a 0-1 on 2 separate occasions. If positive on both occasions then radiofrequency ablation technology would be the best option. However, if this diagnostic lumbar medial branch is negative at L5-S1 then have a diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive on 2 separate occasions I would consider a steroid injection 1 time into the SIJ with a pelvic stabilization program. If the pain is still not better in 3 to 4 months I would consider minimally invasive sacroiliac joint fusion using IFUSE. Please refer to my sacroiliac joint injection article on spine health for components to the sacroiliac joint injection for diagnostic purposes.




Rick:
I am 53, and have lived with low and mid back pain for almost 30 years now. I have a tilted pelvis from an accident at 5 years old, mild scoliosis, osteoporosis, arthritis, and wedging of my vertebrae, just to name a few. I have still managed to lead a physically active life up until 8 years ago, but slowly I had to stop many activities. About three years ago, my back was so painful that a 1 liter jug of milk from the fridge was too heavy. My doctor sent me to an endocrinologist, which was no help at all, and to physiotherapy.

Physiotherapy sent me home with a rubber band to do exercises for two weeks. I was to call them at the end of two weeks and report. When I told them there was no improvement, the physiotherapist told me that I should be better, and not worse. So I informed her that it took me almost thirty years to get this bad, it wasn't going away with two weeks of therapy; I never heard from her again. A year later, I pushed my doctor into sending me for a MRI, which showed I had three bulging disks, even though he had previously told me that in x-rays my discs were fine. He set up a new appointment with a physiotherapist, which will probably come about in another year.

My biggest problem is standing. If I stand in one spot for five minutes, I'm in low back pain, and the pain doubles every five minutes. I recently had to stand for a long period of time, and was in so much pain, I could barely walk. I went to my doctor and he said my sciatic nerve was inflamed (I had almost no reflexes in my right leg) so he injected a cortisone shot (about my 25th) in my sciatic nerve. It took almost a month just to get back to my version of normal (unable to work, but not suffering too much). Sometimes it happens to the right side, sometimes the left, and it will definitely happen if I lift anything over 20 lbs.

Do you have any suggestions?

Thanks

Dr. Patel:
If your main issue is standing I would have your facet joints evaluated. Typically a diagnostic lumbar medial branch block at the level where you are having your pain should be performed. Each injection should demonstrate a pain intensity reduction of a 0-1/10 on 2 separate occasions for the duration of the anesthetic injected. If this is the case and positive then radiofrequency ablation technology should be the next step.




Prashant:
I’m a 26 year old male and I have been experiencing pain in my mid to upper back only during the night. I have been diagnosed with bilateral sacroiliitis by MRI scan. I have some literature about this disease and it seems that there is no permanent solution to this. I have also found that people suffering from this disease have pain in lower back and buttocks, which I don't have. My symptoms and other people symptoms are not same. So, I just wanted to ask if my symptoms also indicate bilateral sacroiliitis or not.

I also wanted to know if there is a permanent solution to this disease or not.

Thanks & Regards

Dr. Patel:
Unfortunately mid to upper back does not correlate with pain emanating from the sacroiliac joint. Typically sacroiliac joint pain would present with pain along the lumbosacral region or even a little lower. I would consider a thoracic MRI to evaluate for disc pathology, tumor, or even compression fracture depending on your clinical presentation history and exam findings that could corroborative with your symptoms.




Ritika:
My father has recently done his MRI and his report says the following:

The lumbar and included lower dorsal vertebrae reveal degenerative cortical endplate irregularity. Small anterior and posterior marginal osteophytes are noted. Schmorl's nodes are seen along superior and inferior endplates of D8-L4 segments. Microtrabecular compression seen.

Can you please give me some advice for appropriate medication and routine exercises for correction.

Thanks

Dr. Patel:
I will need more information. (1) Location of pain; Mid back, mid lower back or lumbosacral? (2) Worse with standing and walking the greatest or sitting? (3) Is the pain along the low back greater than the buttock down the legs? (4) Which levels is the compression deformity seen?




Sindhu:
Hello doctor, I had been diagnosed with Sacroiliitis in June 2010, although I was experiencing pain from 2007 onwards. I always contributed pain due to my increasing weight and never paid attention. I always experience the pain when I stand for prolonged hours, sometimes even shifting sides while sleeping and also when I walk even for 20 minutes with my flat slippers on. It is a terrible piercing pain which leaves me breathless for a second. In 2010 I took medicines given to me by an orthopedic surgeon; these gave temporary relief and only added to acidity. I am 33 yrs old and weigh 115 kgs

My questions are as follows:

1. Is it curable?

Yes the symptoms can be relieved significantly. I would recommend a diagnostic sacroiliac joint injection under xray guidance. If your pain reduces significantly (0-1/10 pain scale) on 2 separate occasions then consider a pelvic stabilization program and steroid injection into the sij. If not better at 3-6months then consider minimally invasive sacroiliac joint fusion.

2. Is it hereditary as my father's sister and my grandfather's sister both had it.

No these symptoms are not hereditary.

3. What’s the way forward?

Read question 1

4. Home remedies and exercises?

Improve hamstring flexibility while lying on your back. Improve hip flexibility. Improve gluteal strength. Improve hamstring strength.

5. I want to get pregnant next year, will it affect it?

It could especially the third trimester. A sacroiliac joint belt would be necessary. Also hamstring stretches while lying in your back will be necessary.

6. Are there long term hazards due to this such as paralysis or immobilization? I am scared, half of the doctors don’t know what it is and just give me pain killers?

If the pain is from the sacroiliac joint then the risk paralysis is low. However if you are having pain along your waist line that is primarily worse with standing then have your facet joint evaluated at the level of your pain along the lumbar spine by having a diagnostic lumbar medial branch block under xray guidance evaluating for a pain reduction down to 0-1/10 on 2 separate occasions. If positive then I would consider radiofrequency ablation technology in managing your low back pain worse with standing.




Corlette:
I am a 35 year old mom with 26 month old triplets. Since my pregnancy, I’ve been suffering with severe pains in my legs, spine, arms and fingers. I went for numerous checkups but the doctor only gives me panado. The pain has become so bad that my fingers and legs become numb on a daily basis. I have si joint sclerosis and a bone spur. Have been in pain for years.

L5/S1 disk has vacuum phenomenon what does this mean? Any ideas?

I also have have degenerative disk disease, kyhpo-scoliosis, Spina bifida occulta , Scheurmanns disease, lordosis of my neck

Dr. Patel:
The numbness along the hands and legs is concerning. I would have an EMG/NCS of the hand to evaluate carpal tunnel syndrome. If it comes up negative I would recommend an MRI of the cervical spine to see if you have a herniated disc causing cervical stenosis that could corroborative with numbness of the hands and legs at the same time. However, your low back could be emanating from the L5-S1 segment, either the disc or facet joint or the sacroiliac joint. Please refer to the sacroiliac injection article I wrote explaining the purpose of the diagnostic injection to evaluate whether the sacroiliac joint could be correlated with your symptoms. A diagnostic lumbar medial branch block at L5-S1 would an appropriate diagnostic injection to evaluate if your low back could be associated with this pain generator. If this is positive on 2 separate occasions then I would consider radiofrequency ablation technology in management of the low back pain. If it is the disc, based on a negative sacroiliac and medial branch block for diagnostic purposes, then I would consider lumbar traction and McKenzie style stabilization program for clinical disc related pain at L5-S1. If no improvement is seen, consider transforaminal epidural steroid injection 1-2 times. If there is still no improvement then you have achieved maximal medical improvement in my opinion.




Anita:
Please could you explain these MRI results in layman terms:

Normal vertebral alignment throughout. There are several small Schmorls nodes in relation to the lower thoracic levels and upper lumbar spine.there is minimal circumferential disc bulging early marginal osteophytosis anteriorly at L3-4. Disc concavity posteriorly is maintained as are canal dimensions. Minimally appreciable L4-5 disc bulge. No significant findings L5-S1. Normal lower dorsal cord and conus medullaris. No posterior element or marrow findings to note. No incidental perivertebral soft tissue findings.

Dr. Patel:
Essentially degenerative, or “wear and tear like changes” have taken place. Schmorl nodes are created from high pressures along a structure called the endplate where a lot of nutrients come from for the intervertebral disc. Disc bulging is a result of the disc having less hydration and this results in the outer layer of the disc the annulus to bulge out.




Lynne:
Once fused, does the body's motion transfer the jarring that the SI joint used to buffer to other joints? Does this create a further risk of slipped discs etc, to the L5 or L4 region? What are the reactions of the fused side to the other side of the sacrum?

Dr. Patel:
If the SIJ is fused, the opposite sacroiliac joint has less motion according to a European spine surgeon. If the lumbar spine is fused at L4-5 and/or L5-S1 then increased stress may be placed on the sacroiliac joint. Adjacent segmental stress is a common occurrence after fusion of the lumbar spine. Also, stress above the fusion is also something to consider where the disc may become degenerative and cause a possibility of a disc bulge, herniation etc; anything is possible. However, the most important thing is to accurately correlate your current symptoms with a structure.


AUGUST 2012

Pam:
I injured my sacroiliac joint August 17, 2011 lifting 30 lb boxes at work. I have not been able to find a doctor that can tell me why I am still having severe pain in the left sacroiliac joint, left buttocks, and left leg that has left me with a limp. I have seen 4 doctors about this problem and all 4 have told me the same thing and I quote them "you have had all the best tests money can buy, MRI and CT Scan and the tests show nothing, but sometimes people just have pain that can't be explained" end quote. I also had one doctor say to me and I quote "go back to work and get in a normal routine and I promise you the pain will go away" end quote. Well it has been almost 1year since my injury and I can honestly say my pain is no better than the day I was injured. What advise do you have to offer? Will I be living with this severe chronic pain the rest of my life? I can't even find a doctor that will prescribe any kind of pain medication so I am living on Ibuprofen - about 10 a day.

Dr. Patel:
If the MRI did not demonstrate findings at L5-S1 you should have a diagnostic sacroiliac joint injection under xray guidance to evaluate whether your left sided painful symptoms reduce to a pain level 0-1/10 within the 1st 2 hours. If so, get it repeated for consistency. If the tests are positive again and you have not had significant relief with steroid injection into the sacroiliac joint then I would recommend discussing the possibility of minimally invasive sacroiliac joint fusion using IFUSE. Look at the SIBONE website. They have information about the product and typical work-up etc. Hope this helps.




Patricia:
I had a microdiscectomy in 2003 and a spinal fusion in 2005. My problem was a herniated disc at l5s1. I am having severe pain in my lower back left hip and leg, I am also having pain above the surgical site. Can this procedure be done even though I had the fusion? My pain is worsening every day and even the pain medication is barely helping. I struggle to get out of bed each morning and I am living with icy hot and the heating pad. I do work but am noticing that I can’t do anything else. Will this procedure help me?

How long is the recovery?

Dr. Patel:
Yes. If the pain below the fusion is truly emanating from the sacroiliac joint then a sacroiliac joint fusion using the IFUSE product from SIBONE is a possibility. Make sure you had the a diagnostic sacroiliac joint injection under xray guidance to evaluate whether your left sided painful symptoms reduce to a pain level 0-1/10 within the 1st 2 hours of the injection. If so, get it repeated for consistency. If the results are positive again you should have a steroid injection into the SIJ. If you have not had significant relief with steroid injections into the sacroiliac joint then I would recommend discussing the possibility of minimally invasive sacroiliac joint fusion using IFUSE.




Tammy:
Ok I now know my pain is from my SI joint but my pubic bone is also separated. My question is can I fuse my SI joint with out fixing my pubic bone???

Dr. Patel:
It all depends on how much pubic pain you are having. If the SIJ pain is worse with minimal pubic pain get the IFUSE done first and reassess the pubic symptoms. If the pubic rami joint pain is worse than the SIJ pain then get the pubic rami joint pain addressed. Ask the surgeon what can be done for the pubic rami joint pain surgically if the pubic pain is a significant problem for you. Hope this helps.




James:
Just wondering if you could send me on a list of surgeons in Europe who carry out the ifuse procedure?

Dr. Patel:
Yes. Please go the SIBONE website and call them directly. They have a number on the website and will provide a list of European trained surgeons for the IFUSE product. Hope this helps.




Beverly:
Why is pain in my lower back worse after having bone graph fusion last year, July?

Dr. Patel:
If the pain feels lower than the prior surgery, it is possible that the pain is different and related to adjacent segmental stress from the spinal fusion you had last year. It is possible the sacroiliac joint could be the source of pain. Please read my articles on sacroiliac joint dysfunction and injections so you have a prior understanding of this condition prior to seeing a specialist. Hope this helps.




Swagata:
I have had lower back pain for the last 2-3 months. Movement is, at times, hesitant because of my pain. From an X-Ray of AP, lateral, and both oblique views of lumbar spine, I have been diagnosed to have degenerative disc disease at L3-L4 and L5-S1 with Grade 1 anterolisthesis. Also, anterior osteophytes at multiple levels are present. The pedicies of the lumber vertebra appear intact, no evidence of fracture, no other loss of vertebral body height or intervertebral disc space height is noted.

I am 63 years old, in very active shape, working as an engineer. I have Rheumatiod Arthritis; I take 50 gm of Enbrel once a week and 1 tablet of Leflunomide.

My questions- a) Is there any treatment other than physical therapy which I have started, 2) how fast it can deteriorate? Can this progression be arrested? Can you refer any doctor in Maryland near the capital area please?

Dr. Patel:
If you have pain close to your waist line that is worse with standing and walking more than sitting it is possible the facet joint at L5-S1 could be the source of the pain secondary to the grade 1 anterolisthesis. To prove this you would need a diagnostic lumbar medial branch block bilaterally at L5-S1. If tested positive for at least an 80 percent reduction of you concordant symptoms with functional activities within the first 1-3 hours post-injection on 2 separate occasions then a radiofrequency ablation is an excellent option with the mean duration of relief being 10-12 months with a single treatment without having to need surgery.

However, if the facet joint at L5-S1 is not the pain generator then have the sacroiliac joint evaluated with a diagnostic injection under xray guidance. I have an article on spine health that clearly discusses the difference between a diagnostic versus a therapeutic sacroiliac injection. If positive improvement is seen using the protocol mentioned in the article and you have not obtained at least 6 weeks of relief from a therapeutic SIJ injection under xray guidance then I would consider IFUSE procedure from SIBONE.

If you need an interventional spine specialist to evaluate this call International Spine Intervention Society and ask for a specialist close to your zip code.

Hope this helps.




Pam:
I have had an MRI, an epidural steroid shot L5-S1, a shot in the facet joint, and 1 shot in my hip joint; also surgery On 3 discs in my neck (June 11,2012). My doctor says he can't see what's causing my sciatica pain. What do you recommend next? I know when I return to work, my sciatic pain is still going to kill me!

Dr. Patel:
The sacroiliac joint could be the source of the referred leg pain. I would recommend a diagnostic sacroiliac joint injection under fluoroscopic guidance where contrast is used to confirm needle placement injecting only anesthetic into the sacroiliac joint evaluating for a pain intensity score of 0-1/10 within the first 3 hours post-injection on 2 separate occasions. If both diagnostic injections are positive, then I would recommend manual therapy with a PT and steroid injection 1-2 times into the SIJ. If you fail to get at least 3-6 months of relief then I would consider IFUSE from SIBONE. This is a minimally invasive SIJ fusion. Let me know if this doesn’t turn out to be your painful generator. Hope this helps.




Nicole:
At the age of 16, I was diagnosed with Spondialothesis. They were doing a bone density scan on me and the x ray revealed an extra vertebra in my lower spine that was causing all my childhood back pains that had always been written off as growing pains. The vertebra has now tilted to a slight angle causing the disc and vertebrae below to rub. I'm now 23 years old and almost completely incapable of lifting anything over 15 pounds without winding up laying down for the rest of the night. I've been seeing my primary care doctor once a month for OMT's to straighten my spine, neck and hips back into place but I just feel there was more that could be done so I can live a normal life again and not feel completely restricted to the activities I do. Bike riding, running, long walks, etc. all cause major lower back irritation. I've tried yoga and Pilates to help strengthen my core, but even attempting activities such as these are discomforting and sometimes painful. Can you have a surgery to remove a vertebra without having to place something in place of it and be okay? How long of a recovery would it take? Would I have a large possibility of the surgery going terribly wrong? I'm still very young and completely uncertain of how to go about dealing with my birth defect.

Dr. Patel:
Removing the vertebra is not a good viable option. If you re noticing more pain going from sit to stand, standing and walking more than sitting then have a diagnostic lumbar medial branch block at the spondylolithesis level bilaterally. If you notice a pain intensity score of a 0-1/10 within the first 1-3 hours of the injection on 2 separate occasions then radiofrequency ablation of the medial branches is an excellent viable option with a mean duration of relief of 10-12 months.

However, with the extra vertebrae it is possible the sacroiliac joint is source of the pain and a diagnostic injection into this area would need to be performed. Please refer to my articles on Spine-Health for Sacroiliac joint Dysfunction and sacroiliac joint injections.

Hope this helps.




T:
About 1 year ago I started getting severe pain and swelling in my feet to the point where I couldn't walk, this lasted about 5 months. In that time my shoulder started to be in pain where I could not rotate my arm. I finally went to a physiotherapist who gave me a few exercises to do and explained this pain is coming from my back. A few weeks later my shoulder and leg had very little pain and all of a sudden my back was crippling me. I needed help to turn over and get out of bed. Since my back is getting much worse, I am having difficulty breathing and doing anything that involves moving. So I had x-rays of my spine to find out what had happened. The X-Ray report showed C6-C7 minimal narrowing with marginal spurring and posterior spurring in C5-C6//mid to upper thoracic spine has a 20% curve to the right with significant narrowing of D4-D5 and D5-D6//L5 spondylolysis with grade 1 anterolistheses with L5 sitting on S1 by 8mm//degenerative change inferior aspect right sacroiliac joint.

My family doctor says I have arthritis and degenerated discs he referred me to a Rheumatologist and sent me for blood work to rule out rheumatoid arthritis. I don't have that, I have gout. I was about 13 (31now) when I fell on my tailbone playing hockey when the L5 sitting on S1 by 8mm problem started as the chiropractor I was sent to showed me. Now I decided to go to a physiotherapist again where he looked at my x-rays and said he can't help me at all this is scoliosis. I don't understand all of this, but I feel like I'm being sent to the wrong people. I was told when I was 13 when I was injured like that I may require surgery to correct it. The physiotherapist is now saying the same thing and I was also given a referral to an orthopedic surgeon, which would make my 4th trip to him for him to do nothing as I was sent for my knee/leg/shoulder issues that had nothing to do with that. Please advise me what I should do, what exactly is happening to me and which type of surgeon I should ask for a referral to.

Thank You for your time

Dr. Patel:
If you have pain close to your waist line worse with standing and walking more than sitting it is possible the facet joint at L5-S1 could be the source of the pain secondary to the grade 1 anterolisthesis. To prove this you would need a diagnostic lumbar medial branch block bilaterally at L5-S1. If this is positive for at least an 80 percent reduction of you concordant symptoms with functional activities within the first 1-3 hours post-injection on 2 separate occasions then a radiofrequency ablation is an excellent option with the mean duration of relief being 10-12 months with a single treatment without having to need surgery.




Nestor:
Dear Doctor, I am a 45 years old male, that since 2001 has suffered chronic back pain due a car accident. My spine has been reconstructed, I had a fusion done, and many injections, they seem to work for a while but pain comes back.

Dr. Patel:
If you having lumbosacral pain (along the waistline or below along the buttock region) it is possible that sacroiliac joint could be the source of the pain from adjacent segmental stress causing pain from the fusion below. A diagnostic sacroiliac joint under xray guidance is the current gold standard to evaluate whether your painful symptoms reduce to 0-1/10 with the first 1-3 hours post injection on 2 separate occasions. If the results are positive and therapeutic sacroiliac joint injections did provide you with at least 6 weeks of relief then I would consider the IFUSE Product from SIBONE. This is a minimally invasive SIJ fusion. Hope this helps.




Gloria:
I had a right SI fusion with the Ifuse system in January of 2008, 2 months after having L5/S1 fusion (both from traumatic injury). My SI had been doing fine, until 3-4 months ago, when I started having episodes of severe R SI pain to the point I have fallen on multiple occasions if I'm walking when it happens. Yesterday, I had a 10 minute window when I couldn't even walk, it felt "locked up", like my gears were out of alignment. I am very concerned, and don't know what to do. Can I still try cortisone injections with the implants in place? Is there a rate of failure or complications - ie non-fusion or hardware pressing on nerves? I have to say, it does feel at times like something is moving in SI, and I have had "clunking" sensation. Any input would be greatly appreciated, I am scared and don't know what to do. I would really appreciate names of surgeons in NH or MA who perform this surgery, so I can pick one.

Dr. Patel:
I would talk to the surgeon to evaluate whether the implants have loosened. A CT of the SIJ would help evaluate whether the SIJ has fused or not at this point. Also, here is possibility depending on your bone mineral density z scores are indicative of osteopenia or osteoporosis an MRI of the sacrum would be necessary t evaluate for sacral stress fracture. If the CT demonstrates fusion with no loosening and MRI demonstrates no stress fracture then I would recommend a steroid injection into the distal portion of the SIJ under x-ray guidance. You can also email SI-BONE at patient@si-bone.com for additional information and surgeon referrals. Hope this helps.


JULY 2012

Kim:
I am an endurance athlete suffering from bilateral ''migrating" nerve pain in my legs. I have had an anterior/posterior L5-S1 fusion without resolution of the pain. I have not been able to work for 2 years and am intermittently home bound. Currently, I have been home bound for almost 4 months, except for doctors appointments. We finally feel like we have isolated the sacroiliac joint as the culprit and are looking at sacroiliac joint fusion. What are the current recommendations for bilateral fusions and is returning to an active lifestyle an appropriate goal?

Dr. Patel:
The recommendations for SIJ fusions are the following:

  1. Positive diagnostic sacroiliac joint injection under fluoroscopy using contrast to confirm proper needle placement injecting only an anesthetic demonstrating on 2 separate occasions greater than or equal to a 75 percent reduction of your painful symptoms with provocative activities.
  2. Unresponsive to 16 weeks of physical therapy, activity modifications, prescription NSAIDS
  3. Intra-articular SIJ injections under xray guidance did not demonstrate at least 6 weeks of satisfactory relief.
  4. However I would call your insurance company and ascertain what the medical necessity criteria for SIJ fusion.
  5. I would call SIBone and ask for assistance for question number 4 and possible referral to surgeon if this has not been undertaken.



Deena:
I am a 41 year old female, and have recently experienced hip and lower back pain and it hurts when sitting and standing back up. Once I am up I feel okay, but sitting is painful. The pain is in my right hip and lower back area on the right side. It has been going on for almost a week now. I recently drove a 9 -11 hour trip for vacation, went on two rides at the amusement park, one being a rollercoaster with twists and turns(could that be my issue?). Five days later I was back in the car for the 9 -11 hour return trip home. I have been home for 3 days now and it’s been very painful to stand up from a seated position. Again it’s on my right side and right leg. I am a healthy woman with no health issues (except for endometriosis/firbroids). Help me! I am getting very scared, what should I do????

Dr. Patel:
If you are having severe pain along the lumbosacral region of the right side and this is more severe than the pain from the buttock (hip region), it is possible the disc at L5-S1 could be the reason you are having the pain, especially since it is aggravated with prolonged sitting the greatest. However, the sacroiliac joint on the right could have been irritated. I would recommend taking a Medrol dose pack under supervision of a physician and see if this will calm the symptoms. If they become more tolerable start physical therapy for 6 sessions and see which stretches and strengthening exercise help to alleviate the pain. If this does not make it better, obtain an MRI of the lumbar spine without contrast and evaluate the L5-S1 disc space. If the L5-S1 segment is normal, then obtain a referral for a SIJ injection and see if this helps. Let me know how things turn out.




Samidurai:
I am suffering from back pain L4-L5, L5-S1 disc problems. I took steroid injections once a week but I still have pain, please explain about the steroid injections.

Dr. Patel:
If you are having back pain an epidural injection may help to reduce the low back symptoms. The evidence in support of epidural injections for back pain is lacking, however, still considered standard practice for some interventional pain management physicians. Epidural injections can be performed via transforaminal, interlaminar, and caudal. I would recommend a bilateral transforaminal epidural injection 1 time and judge the constant pain at 2 weeks. If the pain is tolerable then start lumbar traction and hamstring stretches while lying on your back. Hope this helps.




Shirley:
I have been diagnosed with Sacroiliac Joint and hip problems. I have had a cortisone injection and they want to do more, but the first one didn’t help much. I think I have seen that Baxyl could be used to lessen the pain and inflammation. I don’t have bulging disc but I am in a lot of pain down the leg from the hip.

Dr. Patel:
I would recommend a diagnostic sacroiliac joint injection at this point not a therapeutic one. This way you have the confidence of judging within the first 2 hours how much pain relief you obtaining with a simple anesthetic placed into the SIJ under xray guidance. The pain intensity should feel like a 0-1/10 within the first 2 hours of the diagnostic injection. Please read below as the current gold standard for SIJ pain syndrome.

1. Positive diagnostic sacroiliac joint injection under fluoroscopy using contrast to confirm proper needle placement injecting only an anesthetic demonstrating on 2 separate occasions greater than or equal to a 75 percent reduction of your painful symptoms with provocative activities.




Venkat:
I underwent L5 S1 fusion in 2005. Even though I have got relief from sciatica pain I have not had relief from my calf muscle pain on both legs. The pain is constant. I am regularly doing physical exercise daily for 1 hour as suggested by my doctor. I am 52 years old. I am not able to walk or stand more than 30 min. I am not diabetic or BP.

Dr. Patel:
I would obtain an MRI of the lumbar spine with and without contrast to see if perineural fibroisis exist around the S1 nerve root. If it does, get a bilateral S1 transforaminal epidural injection time and start a neurolytic agent at the same time (Neurontin or Lyrica). If the pain still doesn’t improve, consider a spinal cord stimulator trial. If this helps for significant pain relief along the posterior calf and it can be implanted permanently by a surgeon. However, if the MRI is negative on the scar tissue around the S1 nerve root, obtain a diagnostic sacroiliac joint injection under xray guidance and see how much improvement you find in the calf pain within 1-2 hours after the injection. Hope this helps.




Kathy:
Can you bill trigger point injections along with SI injections or epidural blocks?

Dr. Patel:
I am not sure. Contact your insurance company and obtain the CPT codes the physician wants to bill. I would say yes if the trigger point injection was performed along the cervical or thoracic region.




Tara:
I have been seeing a chiropractor for about 3 weeks since my lower back began giving me problems. She told me my sacrum was out and adjusted me 3 times a week. I was starting to have sciatic nerve issues as well. I was getting better but then walked around Philadelphia all day, and the next day I was in excruciating pain and my foot was numb. I couldn't walk at all, lying down was best but then the pain got so terrible I had to go to ER. They said that it is probably a bulging disc and did the adjustments to my sacrum; this caused my sciatic nerve to act up. Did they irritate my disc further?

Dr. Patel:
No. Manual adjustments are safe. I would obtain an MRI of the lumbar spine and see if there is a structural finding that could correlate with your leg pain. If the specialists you see does not feel the MRI corroborates the symptoms of the right leg pain then obtain a diagnostic sacroiliac joint injection under xray guidance and see how much better the right lower limb symptoms feel within the first 2 hours.




BJ:
I suffer from awful neck & back pain, have large knots under my shoulder blades and my neck is often swollen. I also suffer from migraine headaches and my arms often ache from lack of blood flow, I was recently told my spine has no curve which is causing these problems. If so what can be done to help with pain?

Dr. Patel:
First order of business is to understand why you have the symptoms. I would recommend seeing a spine specialist who can perform a diagnostic spinal injection appropriately to identify what could be causing the neck and upper limb pain. Typically, the starting point would be to order radiographs and/or an MRI of the cervical spine before developing an interventional based diagnostic injection approach. Hope this helps.




Joe:
I’m a painter and have dealt with lower back pain, pinched nerve and 3 hernias. Now I get painful popping in my lower back.

Dr. Patel:
Unfortunately, if the specialists feel the pain is discogenic in nature then lumbar traction and improving hamstring flexibility are your best options to maintain good functional relief long-term. I would also improve lower extremity strength. You can use epidural injections for flare-up or oral steroids. The popping you are referring to may be what is called crepitus, which essentially is tightness along the interface between muscles, ligaments and fascia.




Bonnie:
I can't stand straight up on my right side. I was told to lay on my stomach to stretch my muscles but I can't lay on my stomach on the right side. It pulls and aches and feels pinched in my lower back off to the side. I have been trying to get help for well over a year. This has caused the muscles in my right thigh to become in a constant state of being constricted. When I look in the mirror I can see that my left hip is higher than my right hip. I am definitely off kilter. Leaning to the right.

Dr. Patel:
It is possible the facet joint at L5-S1 or the sacroiliac joint on the right could be the source of the pain. I would get referred to a specialist who can perform a diagnostic injection to evaluate these 2 structures on separate visits. After each diagnostic injection see how low the pain intensity is along the right side of the lumbar spine and right thigh. Once you and the interventional specialist agree what the major pain generator is, discuss treatment options.




Keilyann:
I will do my best to be brief. First off, thank you for your time in acknowledging my issue. I will try to set a time line to make this less confusing.

I was injured in April 2009 while standing on the front of a truck that hit an object, and I lost my footing, slamming my feet straight down into the truck. (I was given the term ""vertical shear"" as to what happened.) I "toughed it out" and finally went to the ER. I was told I had back spasms and could return to work in 7 days.

In that time, the pain got worse. It was worst across the top of my right hip, and spasms were in my ribs. I went to a clinic which prescribed pain meds, PT, MRI and an ortho/neuro consult. The ortho immediately wanted to perform lumbar injections based on my MRI. I refused, explaining the pain was "lower”. The PT exam revealed upslip of SIJ. Many adjustments were performed as well as SI belt and strengthening exercises which yielded much relief, but the pain returned when SI belt was removed. Unable to adjust myself to the level of comfort PT could.

The neuro said this was "non-surgical," and prescribed an SI belt and dismissed me to pain management; pain management offered countless MRIs, EMGs, narcotics and injections. This was all very temporary relief, and by December 09, I was fed up; I requested referral to a new doctor.

The new doctor, also pain management, sent me to a surgeon for consult. By May 2010 I had a right SIJ fusion, 2 screws placed. Woke up from surgery pain free (as pain free as can be expected.) Within a few hours of anesthesia wearing off, I had excruciating left hip/buttock pain. I believe my husband recalled me saying, "I think my hip is broken!" X-rays showed no fractures. I was unable to do PT prior to being discharged, and besides being non-weight bearing on the right, I was unable to bear any on the left and had to have 12 weeks in a wheelchair/walker.

Post surgery nuclear bone scan showed only significant inflammation on the unaffected left SIJ.

August 2010 to present: 12 weeks PT, trials of medications, injections (epidural Sarapin gave incredible relief, but new doc refuses, due to "high risk of infection" but insists he should do RFA.) Current medicines- Cymbalta, Lyrica, Daypro, xanaflex, nexium, Lidoderm patches, OTC linements. Currently in PT 3X's a week. PT advised me that my piriformis is likely the source of my pain. The pain decreases significantly with massage/trigger point therapy, but quickly returns. My current pain management doctor has told me that the right SI fusion cannot be related to my current complaint of left SIJ and left piriformis pain. But I argue, simply based on anatomy and mechanics that he is wrong. (FYI- this doc has tried to blame symptoms on everything BUT my SIJ. Including- kidney stones, gastritis, hernia..... Just to name a few. All were proven to not be an issue.) Yes, I know I need a new doctor, but with 3+ years of records and crappy insurance, it’s very difficult, but I'm working on it.

Question(s)-
-If I had my Right SIJ fused, could I now have pain in the Left SIJ?
-Could my right side fusion have been a factor to this ""new"" left SI/piriformis pain?
-If it is indeed my piriformis causing the pain, after 2 years, will PT alone rid this pain?
-Can my SIJ pain cause occasional anterior pelvic pain?
-Could the left sided issues been present due to compensation after initial injury, and once fused, and minimized pain to the ""affected"" side, cause the left side pain to now show its true colors?
-Would removing screws or releasing piriformis surgically or left SIJ fusion be a benefit or a waste?

Thank you again for your time.




Dr. Patel:
I would agree that once SIJ fusion has taken place that motion on the unaffected side does reduce. This is accordance to a European surgeon who was instrumental describing the micromotion that occurs across the sacroiliac joint. Simply stating the right sacroiliac joint fusion developed left SIJ pain as a flow through mechanism. See a spine specialist who can perform the left side. Make sure you have diagnostic sacroiliac joints injections to corroborate the painful findings with this structure before moving forward with the fusion of the SIJ.

I feel the piriformis muscle pain is a secondary issue. You and the specialists need to evaluate what percent improvement of the left sided symptoms demonstrates after an anesthetic injection into the sacroiliac joint.

SIJ pain can cause anterior pelvic pain because pain sensitive fibers exist along the anterior portion of the SIJ. However this is not common.

I would not consider a pirformis release unless the diagnostic injection of the SIJ on the left did not bring the VAS pain score down to a 0-1 within the first 2 hours post injection.


JUNE 2012

Cara:
I have suffered for years with pain in my lower back and hips, I have had physio for the past two years and she has told me I have a twisted pelvis and twisted sacrum along with my L5. I am in constant pain and can't take strong pain killers, but my doctors don't understand or believe me. Could I be suffering from SI.

Dr. Patel:
Yes you could. The current gold standard toward ascertaining whether the sacroiliac joint could be associated with your painful symptoms is to have a diagnostic sacroiliac joint injection on 2 separate occasions demonstrating at least a 75 percent reduction of your painful symptoms with sacroiliac joint provocative testing or functional activities.




Ferdnand:
I had a big problem on the right side of my right knee, I feel pain after I run or jump playing football. I supposed to have a football trial in the last 3 months, but I couldn't because of that. I went to do an MRI scan but it showed nothing wrong on my knee. I don't know what to do next. Please help me, football is the only thing I'm good at. I really want to get back in the pitch.

Dr. Patel:
Having pain just along the right side of the knee with a normal MRI of the right knee is difficult one. If you have buttock pain and at times numbness and tingling or pain along the lateral aspect of the calf all at the same time it could be an L5 nerve root problems because of a herniated disc. However, if it is just lateral knee pain, I would consider an MR arthrogram of the right knee. Sometimes regular MRIs of the knee miss these things. Hope this helps.




Shahid:
I am 34 yrs of age. I have been suffering from low back pain from the last 17 yrs. It started when I had lifted a heavy gas cylinder. The pain is on the right side of my spine. I have tried everything from physiotherapy to yoga, but the pain remains. I exercise daily to keep my back strong. The pain is recurring in nature, meaning it increases every one or one & half months and it lasts for 3-4 days, during which time I have to take bed rest & then the pain subsides. The rest of the time there is very little or almost no pain if I don't do any kind of strenous activity. After learning about the sacroiliac joint from this website, I suspect that my back pain is related to it.

Dr. Patel:
I would first obtain and MRI of the lumbar spine without contrast to see what the health of the disc at L5-S1 looks like. I would still keep sacroiliac joint pain syndrome as part of the differential but it will be important to understand what doesn’t look normal along the lumbar spine at L5-S1.




Shakilla:
I had a spinal fusion done in July 2005. Four days after surgery I felt my right feet getting numb. Since then the right foot is still the same. The doctor was informed. He mentioned that it will take some time (it has been 7 years). I have been to a Specialist Neurologist, he diagnosed residual symptoms and signs of a right S1 radiculopathy with fibromyalgia. I am in constant pain. It is serve at night. I have sleepless nights and tired late morning. I am taking 4 tramacet pain killers at night but still restless. Please help.

Dr. Patel:
Prior to your surgery if you were having a lot pain along the right foot and it converted into numbness and tingling pain, then the surgery helped to take pressure off the nerve root but you have a permanent nerve root injury from the constant pressure along the nerve root prior to the surgery. However, if you are having significant buttock pain along the right foot numbness this could be pain emanating from the sacroiliac joint region on the right and would recommend a diagnostic sacroiliac joint injection under xray guidance to see if this helps to reduce the symptoms by at least 75 to 80 percent on 2 separate occasions. Please refer to sacroiliac joint injection articles on Spine-health as a source of reference.




Somnath:
Last week a my family doctor referred my father to an orthopedic doctor for a MRI scan. The report is very complected and hard to understand. Here are some details about the report:

  • Impression: Bulge of D12/L1 to L5/S1 inter vertebral disc space with thickening and calcification of anterior longitudinal ligament (from D12/L1 to L2/3) resulting in canal steno sis,neural-foramina and nerve-root compression
  • Compresses D10 vertebrate without any evidence of cord compression

It would be very great pleasure if you help me by explaining all the things written in this report.

Dr. Patel:
Unfortunately what this report is suggesting is your father has arthritis affecting the disc and ligaments, and this has resulted in narrowing of the spinal canal. Now the specialist has to correlate the symptoms with the findings on the MRI. Some of the findings are pre-existing and not aggravated while some are.




Candice:
I have been to a pain management clinic and had my MRI reviewed and it come back clean. I have severe lower back pain that goes down both legs to my feet. While I was doing pain management I had an epidural and steroid injection in my lower back that didn't work at all. I had no relief 3 weeks later. I had mbnb done on my right side (L4-S1) and still had no relief. So I went back to my local doctor and he checked my SI joint and my left leg was a half inch shorter than my right. So I went to a physical therapist and had my SI put back in place and I am still having severe lower back pain with numbness going down both legs. I have to have help walking and getting up. I need answers to why I'm hurting so bad!

Dr. Patel:
If the MRI is normal, it is difficult to understand why spinal injections were performed in the first place. It is possible that your pain is emanating from the sacroiliac joint. The current gold standard of obtaining this diagnosis, if possible, is to perform an x-ray guided sacroiliac joint injection evaluating for at least a 75 to 80 percent reduction of your painful symptoms on 2 separate occasions. Please refer to the sacroiliac joint injection article from Spine-health.




Veronica:
I had the Radiofrequency to my left SI joint. How long should I wait until I can see a big difference? I still feel some pain on my left buttock.

Dr. Patel:
Typically symptoms will fluctuate within 1-4 weeks and will be more consistent from 8 to 12 weeks.




Vanessa:
what has the most successful results to deal with scar tissue compressing a nerve after having L5 & L4 fused. I have tried epidural shots, acupuncture, deep tissue massage.

Dr. Patel:
Consider the Spinal cord stimulator trial. If positive at least a 75 percent reduction of your leg pain then I would get it implanted permanently.




Pam:
I have a lot of popping/crunching in my lower back. The pain goes into the buttocks. Something feels loose.

Dr. Patel:
Talk your spine specialist and see if the symtpoms are concerning based on a physical examination.




Arelenar:
My leg gave out I could not stand up on my leg and later my hip started hurting, so I went to the hospital. Last night, I got all x-rays and a CAT scan. The Dr. Told me everything was fine.

Dr. Patel:
If it was the first time this happened, give it 1 or 2 weeks. If not, it would be better then to ask your family physician to refer you to a physical therapist and start NSAIDS. If you are still not better, consider an MRI of the lumbar spine if your spine specialist feels the pain is radicular in nature. If the MRI is normal, consider the sacroiliac joint as the source of the pain and have a diagnostic sacroiliac joint injection under fluoroscopic guidance performed to evaluate whether your painful symptoms reduce by at least a 75 to 80 percent with functional activities of daily living.




Mangesh:
Hi, I am suffering from a lower back problem since 1996. I am 47 years old and I have been to many orthopedic and spinal doctors in Mumbai and also done the MRI test but nobody is able to diagnose the reason for my lower back pain. If I walk for more than 30 minutes or if I sit for more than 2 hours in one position or if I drive for more than an hour I start feeling discomfort in my lower back. I regularly do the lower back strengthening exercises but still it does not help. At times, I get frustrated because of this back pain. I just came across this SI joint problem site and would like to know if there are any doctors available in Mumbai for SI joint diagnosis.

Dr. Patel:
I would call the International Spinal Intervention Society (ISIS) and ask for the physicians in Mumbai. Hope this helps.




Jackie:
I have a spinal fusion question. I had one in August of 2010; there were no drains put in and I developed a fluid leak. I had a compression fracture of the 3rd vertebra. They had to operate on me again and put drains in. Then I had a 3rd operation where they re-cemented me. Then, I had a 4th operation due to the wrong screws put in. They were too small and fell out. I was opened up again and had larger screws put in my back along with rods. I nearly died one night from very severe double pneumonia and my oxygen level dropping down to 60%. I was in the hospital and sub-acute centers (nursing homes for physical therapy) for seven months. I laid in bed for 13 weeks. It is now almost two years later and I am still in constant pain, hunched over, and cannot walk or stand without a walker. I am in physical therapy and on painkillers, depressed and feel hopeless. The surgeon who did it is world renowned and turned out to be my worst nightmare. What I want to know is if being hunched over due to this horrible operation (spinal fusion) will I ever stand straight up again? I am getting sicker and sicker over this. I am on anti-depressants. I cannot live alone anymore. I not only feel hopeless but I also feel helpless. Please someone answer my question of ever standing up straight again. My surgeon offered to take out the rods at no cost to me which I will never do.

Dr. Patel:
Sorry for your symptoms. As for the fact you lean forward if you are having trouble standing up straight because of the pain it could be due to the hardware or adjacent segmental stress to the sacroiliac joint if your lumbar fusion extends to L5-S1. If your fusion is solid with bone growth according to the surgeon removing the hardware is fine. As for the painful symptoms if they appear to be along the lumbosacral region get referred to an interventionalist who specializes in fluoroscopic sacroiliac joint injections and see how much improvement you notice after a diagnostic sacroiliac joint injection under fluoroscopic guidance. If you notice at least an 80 percent reduction of your symptoms with functional activity then have it repeated for consistency of results. If positive then have 1 therapeutic injection and if negative consider a minimally invasive sacroiliac joint fusion. Hope this helps.




Chet:
What do you know about the Sacrowedgy, and can it help with SI Joint problems?

Dr. Patel:
I am not familiar with sacrowedgy. Sorry




Dawn:
Hi, I have been suffering with back pain for over 10 years and finally I did have an MRI. My doctor said I have a herniated disk and that he would refer me to a surgeon who can help me. I saw the surgeon who told me that I have degenerated disk disease and he sent me away saying he can’t do anything for me only that I should see pain management team for painkillers. I am in chronic pain all the time I cannot do anything without being in severe pain. I am beside myself, as the pain goes to my hips down my legs to my feet I do not have a normal life because of this and I’m only 53. Please can you give me some help? I have had painkillers injections acupuncture nothing has helped. I don’t know what to do or who to turn to.

Dr. Patel:
If the disc at L5-S1 is degenerated and not herniated you may consider a bilateral lumbar transforaminal epidural at that level 1 time. If you fail to get at least a 40 percent response at 2 weeks consider a diagnostic lumbar medial branch block to anesthetize the zygapophyseal joint at that level. If positive for at least an 80 percent reduction of your low back pain on 2 separate occasions then a radiofrequency neurotomy of the medial branches should help significantly. However if the diagnostic lumbar medial branch block is negative bilaterally then consider diagnostic sacroiliac joint injection under fluoroscopic guidance. If positive for an 80 percent reduction of your symptoms with activities of daily living on 2 separate occasions then consider 1 -4 therapeutic injections. If you fail to progress you may consider minimally invasive sacroiliac joint fusion (ifuse). Hope this helps.




Rosalene:
I was told my L3, L4, & L5 have slipped disks. I have been in constant pain for over six weeks. I am taking pain pills, 3 or 4, just to get out of bed. The pain is disabling. I cannot bear weight and can barely walk. How long does a person stay like this?

Dr. Patel:
Unfortunately patients can have symptoms for a long time. Obtaining an accurate diagnosis is first important step. Just because the MRI demonstrates abnormalities does not mean your pain is emanating from all of the abnormal findings. MRI just detects changes not pain. You should see an interventional spine specialist who does an excellent job of connecting the dots between your symptoms with the MRI of the lumbar spine. If you need a referral call International Spinal Interventional Society and ask for someone in your area. Hope this helps.


MAY 2012

Teri:
I thought my pain/discomfort/nagging weird sensations may be sciatica/numbness in the leg/calf sensations but then I read your article, what should I do? Who should I see? Will my general practitioner be able to diagnose?

Dr. Patel:
Sure. I would see a Physical Medicine and Rehabilitation Specialists. Typically when you have leg pain the important point to evaluate if this is nerve root from the lumbar spine or sacroiliac joint or sciatic nerve issues from a tight pirifromis muscle. They may perform an electrodiagnostic evaluation to see if there exists qualitative damage to the peripheral nerves along the lower limb and may need to order an imaging study of the lumbar spine (eg. MRI). However if the MRI findings does not corroborate with the physical exam and other objective tests performed then the specialists may consider the sacroiliac joint or other structures outside the spine that could be associated with your symptoms. Hope this helps.




Laura:
I have been suffering with back pain for years. Just 4 years ago I had a triple cervical fusion but now I have more pain now than before the fusion. I’m not happy. My lower back is in bad shape; I have no bowel control and have chronic pain from my tail bone up through lumbar region. I also have a lot of old spinal fractures.

I have gone through injections in the lumbar but still am having no bowel control or pain relief. Had MRI and EMG done 2 weeks ago and am now seeing a neurosurgeon. No one has ever said anything to me about my back pain possibly having something to do with my loss of bowel control and this has been an ongoing problem for 15yrs. I have had trauma to my back from falling down stairs and losing control of my motor cycle. I am very frustrated; just want a good out come and no more problems. I am on social security disability because of the problems to my health. I am very skeptical of any doctors at this point because they have seemed to fail me

Dr. Patel:
Your case as a lot of components; I feel the first issue is to ascertain why you have the bowel incontinence. Typically this can be related to cord compression along the cervical or thoracic spine. However you are correct that severe stenosis of the lumbar spine could be associated with bowel incontinence.

As for the pain along the neck your pain may be related to adjacent segmental pain above or below the 3 level fusion you had for the cervical spine. If you saw an interventionalist that performed diagnostic injections to evaluate whether the zygapophyseal joint above or below your surgery is the source of pain and your fusion according to the surgeon is solid then you may need a CT myelogram to ascertain whether you suffer from moderate to severe central stenosis of the cervical spine and you may need decompression anterior or posteriorly depending on which type of surgery you had before.

As for the pain along the lumbar spine your pain may facetogenic, sacroiliac, bone pain from old compression fractures, from lumbar spinal stenosis. Diagnostic injections can be useful if performed correctly to refine this differential and provide with reasonable certainty why you suffer from so much pain low back pain.

Hope this helps.




Deborah:
I am a right AK amputee with injury to my left leg, and use a motorized wheel chair for ambulation. I have been having severe pain in my left buttocks, left hip, and lower back. The pain radiates down my left leg, and I find comfort only in lying on my right side. The lower back pain is not constant, but it is the most severe. The other pain from my buttocks and hip is quite uncomfortable, though I have been able to sustain it with Motrin and other pain relievers. I have also been using heat and exercises. Do you think this could be originating from my SI joint?

Dr. Patel:
It is definitely in the differential but radicular pain from the lumbar spine needs to be ruled out as well. A specialist that deals with sacroiliac joint and radicular pain issues should be able to use objective tests to correlate with the physical exam findings of your left leg to make a more accurate diagnosis.

Hope this helps.




La Rue:
Can an SI joint be repaired when you have hardware/what is the success rate of the surgery? I had two opinions last May; one doctor said I needed three fusions in the neck 8 mm bulge there encroaching spinal cord, and three fusions in lower lumbar with new hardware. I then saw another doctor a month later; that is when he told me my SI joint was gone; I asked him what the success rate for repair was. He told me1/3 of patients have a 42 percent recovery rate; I thought those numbers were kind of strange? He suggested neck traction here at the house 2 times a day 5 min each time, and no neck surgery. I also have a cyst pinching off spinal cord just above tail bone, and the bulge in my neck is encroaching the spinal cord in the neck just below an old fusion at C5-C6. I've been experiencing Chronic Pain ever since a failed spinal surgery syndrome in 2001. I'm feeling like it was missed and that the SI joint was what needed to be repaired vs the fusion. Now I have compromised T spine. The doctor said I had other issues in my T Spine but did not explain anything to me. There is a whole lot going on I find it's affecting my nervous system if that is possible; I have a lot of anxiety and stress. I'm an Artist had I work on tour for eight years throughout the U.S for Mental Health Awareness, I have not been able to create since the first spinal surgery. I have Lupus and Fibromylgia do think I'm at risk having the neck done?

Is there anyway the neck can be addressed along with the T Spine and Lumbar Scaro joint all at the same time? I’m concerned that the weakened T Spine will really take a beating as well as lumbar if my neck is done first. Your doctor suggested the neck first, then the fusions in lumbar with new hardware. (I still feel it’s my SI joint) What do you think? I know I'm like this Rubix cube and fight surgery due to all I went through with the first surgery, but I am spooked with what the results would be. I'm in bed more than out of it. He was going to do surgery on my neck last April but I chickened out. I feel like a walking time bomb. What do you think Doc?

Do you think you could see me and do consult with other Spine Drs at UCLA Spine Clinic for us to come up with a good game plan? I'm sixty four and if I'm going to have these surgeries to correct my problems I don't want to wait much longer.

Dr. Patel:
I would be more than happy to see you and provide an opinion. So when it comes to the neck are you having more pain in the upper limbs more than neck or vice versa? Also which neck movements stimulate the pain the fastest? If you have more arm pain which part of the upper limbs are affected (the anterior, lateral or posterior parts of the arm and forearm?

As for the sacroiliac joint if your previous fusion along the lumbar spine is solid and it has extended down towards to L4-5 or L5-S1 the sacroiliac joint could be the source of the pain and a diagnostic injection under x-ray guidance injecting only anesthetic (lidocaine or Marcaine) would be the most strict standard to ascertaining whether your current set of symptoms could be associated with the sacroiliac joint. Typically if your pain along this region is reduced where the pain is minimal within 30 minutes of the diagnostic injection then it should be repeated for consistency of results.

Hope this helps




Tammy:
I had back surgery on my L3 & L4 and feel so much better; however I have having excruciating pain with my hip and can hardly sit because my tail bone hurts so badly.

What are you thoughts and is this all coming from the SI/L5?

Dr. Patel:
It is possible the pain could adjacent segmental pain from the zygapophyseal joint at L4-5 or L5-S1 or from the sacroiliac joint. I would recommend seeing an interventionalist that will utilize the strict standards published by the International Spinal Interventional Society (ISIS) in performing diagnostic injections to help delineate between the aforementioned pain generators.




Paula:
I keep getting excruciating pain in my spine for which I have been diagnosed with arthritis, spondulosis, and degeneration in my discs. Over the last few months I have been getting severe pain in my lower back where the back pelvis meets my spine; it seems to be on both sides at alternate times, but the left side I am getting excruciating pain around to and in the hip area and noticed its now in the groin area on the left side as well. When this happens I cant stand up on the left leg as its so painful but the worse feeling is that my spine and pelvic area feels really weak and when I try to stand I cant take my own weight on my legs. When laying in bed I am very uncomfortable in this area and on a better night when I can lay on my side for a few minutes I have a feeling of weakness in my back pelvic area that’s pressing onto the joint to the spine. It doesn’t feel quite supported as it should and feels heavy and very painful. Could this be another problem or just my degenerated discs in my spine causing all this as I feel something else is not quite right. Thank you.

Dr. Patel:
Your pain appears to be lumbosacral in nature. The 2 most common structure affected include the L5-S1 zygapophyseal joint bilaterally or the sacroiliac joint bilaterally. I would recommend seeing an interventionalist that uses the International Spine Intervention Society guidelines on performing diagnostic injections to help delineate between these two pain generators.

Hope this helps.




Karla:
I have had this lower, to the left side pain for quite awhile now, but assumed it was my kidneys. Now, a recent test showed that my kidneys appear ok and the doctor said it was probably the sacroiliac. So, I read about it online and here is my couple of questions. First, I am not an athlete; I am a 55 year old woman. It basically began hurting during periomenopause. I see hormones during pregnancy might attribute it, but what about periomenopause or menopause? I have not had an injury, but I was almost beaten to death with a baseball bat all over my body, just do not remember if I got struck in this area or not. I have been taking Etodolac for several years for another situation; is this an acceptable anti-inflammatory medication for this in case it is inflammation? I also read where it is hard to diagnose. Is that true? I mean, most inflammation is able to be seen on X rays or other diagnostic tests. And finally, it is relatively only in the small, left side of my back. It doesn’t go down my legs or other areas as reported on many websites as symptoms; and it hurts, not all, but a lot of the time. I have recently gained some weight, although it began hurting when I was far smaller, like 40 pounds lighter. What is my next step in diagnosis as the doctor just said it was probably this and let me go. Thank you so much for your information.

Dr. Patel:
It is possible the sacroiliac joint could be the issue. People can develop pain all of the sudden. I would recommend seeing a manual physical therapist and see if manual medicine treatments will help alleviate the pain along with some muscle building exercises for the gluteal region along with some stretches along the same area.

If this does not help you may need a diagnostic sacroiliac joint injection under x-ray guidance injecting only an anesthetic to see if your typically pain along the left side is reduced by at least 80 percent with functional activities that typically increase the pain. If positive it should be repeated for consistency of results. If this paradigm proves to negative then the pain may be related to the lumbar spine and this area would need to be evaluated by a specialists.

Hope this helps




Gabby:
I had a cortisone injection in April into my S1 then had restless sleep that night with pain in my right knee & calf muscle. I also felt hot, having to use coldpacks on my forehead during the night & the next day. Also the next day, I woke & my right calf muscle felt like I had pulled a muscle, making it hard to walk and was feeling nauseous. I now suffer from pain in lower back, going into the hip and buttocks. I would say I generally feel off. How long does this last for? (It was my 1st cortisone injection) Thank you, look forward to hearing from you.

Dr. Patel:
If your specialists states you are suffering from a S1 radiculopathy because of the focal disc protrusion to the right at L5-S1 or from spinal stenosis or a synovial cysts and the right S1 transforaminal epidural injection does not demonstrate at least a 40 percent reduction of your painful symptoms in 2 weeks then you may need surgery to address the issue. Typically post injections will last for only 1-3 days. If they last any longer I would consider discussing with your interventionalist for reassurance that the symptoms you are describing are not concerning.

Hope this helps.




Parmod:
Sir, I’m suffering from lower back pain, it has been about four months and is very painful when I sleep. The pain separates at my back and right leg down to my knees and right lumber, please help me.

Dr. Patel:
I would recommend seeing a physical medicine and rehabilitation specialists to evaluate your symptoms. They will be able to perform a physical exam and corroborate these finding with an electrodiagnostic evaluation and an imaging study. It is important to understand whether the pain is more back pain vs lower limb based on the intensity on the symptoms and which activities increase the pain the fastest.

Hope this helps.




David:
I have had off and on chronic back problems for 25+ years; the last 6 years, more on than off. In May 2010, I had a 4 level laminectomy L2-3/L5-S1. The in November 2010 again I had laminectomy of same levels L2-3/L5-s1 and a fusion of L4-5. I really did not get much relief from surgery, at least not pain relief. But my back remains continually tight at all times making it difficult to stand and walk. The pain is now in my lower right back near the buttock and hip. My primary Dr. says it is my SI joint and has done injections there along with oral anti-inflammatory medications. Does this sound like SI joint issue?

Dr. Patel:
It depends. Did you have a sacroiliac joint injection performed under x-ray guidance conformed needle placement with contrast with the only solution injected is an anesthetic not steroid? If yes did it yield a 75 to 80 percent reduction of your right sided symptoms with standing and walking? If yes was this repeated and did yield similar results? If yes then I think it is reasonable to assume to that the sacroiliac joint is the pain generator for your right sided symptoms.

If not then have a diagnostic injection evaluating the zygapophyseal joint on the right at L5-S1.

Hope this helps.




Leonard:
My L-1 joint has completely disintegrated from arthritis. My bone density isn't good enough for the surgeon to go in and replace the dissolved joint with something new to keep the nerves from being pinched. He said if I can work on strengthening my bone mass, and building it up, he believes that he can go in and attach a plate to stabilize the area and probably will be using metal screw's to keep the appliance in place. I've seen pictures of the L-1, and it looks like a horse shoe in shape, all white and chalky looking. I am 71, but in excellent health, except for major arthritis in all C-2 though C-7 (or C-6) bones. Apparently they have all collapsed. Would you suggest working on building the bone mass to correct it undergo that surgery to stop the excruciating pain caused by the L-1 problem? Thank you very much.

Dr. Patel:
Are you having more back pain or pain from the buttock down based on the intensity of the symptoms? If it is more back pain, is it upper middle or lower back region? Also, does standing/walking increase the pain the fastest or sitting? Also, could you type what was exactly stated in the radiology report of L1 level. I should be able to provide feedback with an educated response based on this info.




Susan:
I have been experiencing deep pain just below my right rib cage. When I try to press where the pain is coming from I cannot seem to pinpoint it. At the same time I get pain in my right leg, from the hip all the way down to the foot and it gets more painful when I try to kneel. When I stand or am walking I feel the strain all the way down from the muscle on my right side to the leg. I also get this headache which affects the right side of my head and neck.

Dr. Patel:
As for the leg pain, I would see a specialists to evaluate whether the lower limb pain is from the sacroiliac joint or radicular in nature from the lumbar spine. If you haven’t seen anyone you may start with a physical medicine and rehabilitation specialists first.

Hope this helps.




Terry:
Last year my son had one disc removed and two support rods put in the affecting L4, L5 and S1. He is currently active and pain free.

However, we have a couple of issues at this time.

1) The injury was caused as a result of him being thrown off a bike from being hit by a truck. We are having difficulty with the insurance people related to whether the accident can cause a disc herniation. I need some information on forces (physics and numbers ) that can cause a disc herniation in an accident.

2) One of his titanium rods has broken; a 90 degree break close to one of the set screws. My question is, why?

As you can see, he has all the luck.

Dr. Patel:
As for the disc issues at L4-5 and L5-S1, even if the findings are pre-existing they were probably aggravated by the accident. What I mean is that people can have similar MRI findings and have no low back pain. However if he had no low back pain prior to the accident and developed this low back pain for the first time after the accident then it is reasonable to assume the degenerative changes at L4-5 and L5-S1 was aggravated by the accident. Moreover, this is where the physical exam, MRI and injection studies, can help correlate the low back with the disc pathology (discogram).

As for the hardware, remember bone at his age is physiologic stronger than the hardware and that can happen with anyone with normal bone mineral density.

Hope this helps.




Jodi:
For about 1-1/2 months I have developed excruciating pain in my left groin area as well and my upper buttocks area on the same side and the only thing I think that may have happened is my husband took a bad fall down the stairs (neurological issues) and I tried to help him get up and could not. The pain is so horrible; it hurts worse than anything I have ever been through. Every time I put any weight on my left leg, it is unbearable. I am using a cane and it doesn't help that much. When I get in and out of my car, I literally scream even now. Just getting into the sitting position in my car is horrible pain. Then, shifting my right leg to the gas pedal; I cannot lift my left leg on its own. I have to literally pick up my pants leg to get it in the car and again I scream each time. It is not getting better, but worse each and every day.

Dr. Patel:
It is possible that the pain associated with the sacroiliac joint. Try a Medrol dose pack and see if this helps to reduce the pain. If this does not provide you with significant relief then see a manual therapist and see if manual therapy with stretching helps to reduce the pain. If not, then see an interventionalists who will use standards created by the International Spinal Interventional Society (ISIS) in performing a diagnostic sacroiliac joint injection under x-ray guidance. If positive on 2 separate occasions then it is reasonable to assume the sacroiliac joint could be the source of the pain. However it could also be the L5-S1 disc as well.

Hope this helps.




Sara:
Hello , and thank you for your great web site!!

I am a 22 year old female and I had disc surgery (L5) 2 years ago. I was wondering if am I allowed to do leg lifts? I want to gain some leg muscle and do some body building but I am scared for my spine; am I allowed?

Dr. Patel:
If you had a microdiscectomy for symptomatic radicular pain or fusion procedure I would consult with your surgeon. There is always the risk of reherniation from doing leg press machine or squats. However, I would recommend a weightlifting belt while performing the leg lifts. It serves as another set of abdominal muscle to help support your spine while performing deadlifts, power cleans, squats, or leg presses.

Hope this helps.




Fidelma:
My MRI scans are normal but I’ve had back problems for 8 years. I can’t stand for long or sit on hard or soft chairs; it’s been suggested I have a muscle imbalance. I’ve seen many experts but nothing has helped, especially not the epidural. I carried my son many years ago, he was heavy, but it’s not been right since. I can’t carry heavy things, stoop, or even twist my head sideways or lean forward much. Please help. Thanks.

Dr. Patel:
If the MRI is normal and your pain occurred after the birth of your child I would consider a diagnostic sacroiliac joint injection utilizing the standards created by the International Spinal Intervention Society. If positive on 2 separate occasions I would feel it is reasonable to assume the sacroiliac joint is probably the source of the pain. However, if this is negative then I think your pain is muscular and you may consider manual medicine for the lumbar spine and lower extremity strengthening exercises.

Hope this helps.




Korey:
Hello, thanks for taking time to respond. I had surgery in January, 2005 at the L4-L5, L5-S1 levels for 2 herniated discs where both sciatic nerves were crushed pretty badly. It was a horrible experience but I ended up having a laminectomy, discectomy, and facetectomy on both levels with no fusion. I understand my back will never be anywhere close to normal but I still regularly get sciatic and terrible muscle spasms with stiffness and had a bout where I ended up missing 3 weeks of work last year and about 4 weeks this year as last year's episode didn't really heal or get back to a more "normal" (for me) state. I am overweight and just cannot seem to get anything going that will actually help me lose weight but won't end up aggravating my back.

Dr. Patel:
If your low back region is the worse where the low back pain is aggravated the fastest with standing and walking and greater in pain than the symptoms from the buttock down you may consider getting an evaluation if your pain is related to instability at L4-5 and L5-S1. This could be the reason for the sciatic pain also. When patients get medial facetectomy translation of one vertebra over another is at risk. I would obtain flexion and extension radiographs of the lumbar spine to see if you have excessive movement and if so recommend fusion at those levels. However, if the symptoms are tolerable and more painful from the buttock down maybe a therapeutic selective nerve root injection may be useful to help control the symptoms. If the nerve root injections do not help I would consider the sacroiliac joint and have a diagnostic injection performed using the International Spinal Intervention Society guidelines.




Toni:
I had a L4-5 discetomy in 1994, then a fusion in the L3-4 in 2007. I have told every doctor I have seen, which is about 7, that the pain is mostly in my hips and legs. Now my doctor is telling me that I need another fusion of the L4-5. I have tried to research my problem and I have all of the symptoms of piliformis syndrome. My legs are killing me every day with pain, then I get agitated with restless legs in the evenings, I am absolutely miserable. It seems to relieve the pain a bit when I roll on the Styrofoam but it doesn’t last long. I don’t know where to turn, this is driving me crazy. I guess my mission now is to find a doctor that can at least give me something to relieve my leg problem. Please help me!

Dr. Patel:
Since your fusion has extended to L4-5 it possible that your pain is related to the sacroiliac joint. To evaluate whether your hip pain is associated with sacroiliac joint a diagnostic injection under x-ray guidance utilizing recommendations from the International Spinal Intervention Society should be performed. If positive on 2 separate occasions then I feel it is reasonable to assume that the sacroiliac joint is associated with your pain. Also consider the zygapophyseal joint at L5-S1.

Hope this helps.




Prakash:
I have congenital fusion in my cervical vertebrae of c4 -c5. Because of this I have lot pain in the left side of my neck and left side of my backbone. All of the doctors I have consulted have told me that it is not curable, but I have lot of pain each and every day. Can you please help me?

Dr. Patel:
As for the left side of your neck evaluate whether the zygapophsyeal joint at C3-4 vs C5-6 could be associated with the severe left sided neck pain. I would see an interventionalist who follows the International Spinal Intervention Society recommendations for diagnostic cervical medial branch blocks. I would have the C5-6 or C3-4 level evaluated depending on the location of symptoms. If positive on 2 separate occasions then a radiofrequency ablation may be an excellent option to help with the left sided neck pain.

Hope this helps.




Pat:
I have constant low back pain in the left buttock and thigh with a feeling of weakness when bearing weight on my left leg. My MRI Scan & X-ray of the hips show that neither my spine nor my hips are likely to be the source of my discomfort. However, I seem to be having great difficulty (here in Britain) in persuading the medical profession to look for other sources of the pain. The stock answer is "Keep taking the pain relief and reduced doses of Antidepressants." While I accept this may well be the answer eventually, I would prefer to get an accurate diagnosis of the pain source and if it is possible, to relieve the pain without recourse to a lifetime on medication and the possible long term issues that they may bring. If the answer is surgery then I would prefer to have the surgery while I am young and fit enough to cope with it. The question is: "Are you aware of any hospital/clinic/specialist in the UK who has accepted that this type of pain can be the sacroiliac joint as its source?

Dr. Patel:
What I would do is contact the International Spinal Intervention Society (ISIS) and ask for physicians with members of this organization based in the UK. They will most likely be on board with performing diagnostic injections to ascertain whether the sacroiliac joint could be associated with your current set of symptoms.

Hope this helps.




Daniel:
"I am a young 61 yrs old and have undergone 3 separate lumbar fusions in 1982, 1983, and 1989. The first operation had a bad outcome. My spine was so tight that the surgeon ended up cutting across the muscles to keep the spine open. At time of the surgery I was in perfect shape and I am a very fast healer, but my spine remained open 8 weeks after the surgery, and I lost 28 pounds in the 1st 10 days. This surgery caused the left side of my lower back pain to get worse. I have a LSTV where the S1 is a functional lumbarized segment with a large butterfly transverse process on the left side which is in contact with the top of my Ilium causing a pseudoarticulation joint. The 1st surgery resulted with a very solid fusion from L5 to S1/L6 to S2. Then the 2nd surgery extended the solid fusion from L5 to L4 and also examined all of my previous surgery. The third surgery fused L4 to L3 due to obvious bone fragments extending upwards on the left side into the L4-L3 facet joint. The 2nd & 3rd fusion surgeries were not anything like the 1st surgery (they went well and did not cause any issues as 1st surgery did). As per MRI/etc imaging, not sure L4 to L3 fusion is solid.

In 1993 a left sided SI fusion was attempted as a last ditch effort and due to definitive increased left SI pain post 1st, 2nd, and 3rd lumbar fusions. The left SI fusion with hardware did not fuse. This 4th surgery was very uneventful as the 2nd, and 3rd fusion were. During the SI surgery the pseduoarticualtion joint was clearly observed along with a significantly hypermobile left SI joint, and a verified solid fusion of L4 to L5 to S1/L6 to S2/sacrum. Post surgery the left side SI joint pain continued, along with left side top of lumbar fusion joint pain.

I have never had any true radiating or midline spine pain. Left leg pain was problematic from the beginning, but not radiating, nor any weakening of the left leg noted.

My assessment is that I have never had any disc issues, only a left sided SI LSTV joint issue. And that the solidly fused L4-L5-S1/L6-S2 fusion has caused the fused lumbar to exert more leveraged pain and motion of the left SI joint.

I have been under the care of a recognized Pain Clinic by Dr Richard Rauck since 1994. The pain medication result in a disabling Opiate Induced Constipation situation, along with the SI bone pain and left top of fusion L3-4 facet pain.

With all the new articles regarding LSTV's, I was hoping to get an open assessment of my situation. My career has been ruined/set-aside since 1994 which is a huge waste since it took me many years to become one of the top Petroleum Geologist/Managers in my field. Can you please advise me regarding the SI situation. I do not think I can be pain free, but in my humble opinion the LSTV & SI joint has been my initial pain sources.

I have had numerous studies, injections/blocks of my spine, and I have all my records and film studies. Please help me in whatever way you can. Please, I just want to get back to work contributing to my professional field.

Dr. Patel:
I would agree with you that the sacroiliac joint should be investigated again on the left side. What I would do is call SI-BONE and ask for surgeons in your area performing the iFuse procedure. Maybe it is possible to remove the hardware along the sacroiliac joint on the left side and replace with the iFuse product for better stabilization. Only a surgeon with experience with the open technique you had previously and the latest minimally invasive SI fusion technique using the iFuse product would be the best source of reference. Go to there website and call them and see if they have a surgeon in the area you can see.

Hope this helps.


APRIL 2012

Sarah:
I had my l4/l5 fused in 2007, now I have cracking on either side of the metal work, irritating the nerves, constant pain in my lower back, and in both legs, mainly my right leg, but when the cracking started, I also lose feeling and sensation when I go to the bathroom, I have to take laxatives to go, or I just do not go at all, could my bowel problem be connected with the cracking in my spine, as I had no bowel problem beforehand.

Dr. Patel:
Not sure if your back and leg pain is related to your constipation or not. May want to get a colonoscopy to evaluate your there exists structural problems to your bowels that have changed. However if it is not related to the GI system then it possible you may be suffering from pain adjacent to the hardware like the zygapophyseal joint at L5-S1, the disc at L5-S1 or even the sacroiliac joint.

Currently the diagnostic protocol for the diagnosing sacroiliac joint pain is to perform a diagnostic sacroiliac injection under xray guidance on 2 separate occasions. To evaluate whether the needle is in the joint you need contrast for confirmation. Then the only solution that should be injected to validate that it is diagnostic is a injecting an anesthetic like lidocaine or Marcaine only …. Not steroid! If steroid is injected it is not diagnostic but a therapeutic injection into the sacroiliac joint. However if you typical pain is reduced down to 0-1 from your typical level on both occasions I would recommend 1-2 steroid injections into the sacroiliac joint with manipulation and pelvic stabilization program. However if you fail these simple conservative measures I would definitely recommend the IFUSE procedure from SI-BONE as a surgical next step. Hope this helps




Duawan:
Received my results from most recent MRI, and I'm scared and upset. I am a 38year old female, who fell on concrete three times 12-7-2010. Dr. keeps telling me I'm too young for surgery. I’m always, in pain, injections don't last past a few days, and I'm tired of taking all these pills. I just want my life back. I can't do anything without being in pain. I can't turn my head, I have numbness in my fingers, arms, and legs, and feet.

Dr. Patel:
Unfortunately it is difficult to correlate your symptoms with the pathology described on your MRI. Please tell me which injections you have had under x-ray at this point and at which levels. Second let me know if you have more pain on the right side of your neck or left side. Third, turning your head to which side increases neck pain on which side? Fourth do you have more neck or upper limb pain based on the intensity of the painful symptoms? Fifth did you have a EMG Nerve conduction study and if so what did it show. thanks




Kishor:
I am feeling pain in my leg, when waking up from sleep. It happening in morning. if I am sleeping for 1 or 2 hours at a time it happens.

Dr. Patel:
Not sure if this radicular pain or not. How long has it been going on for? Does it increase with prolonged standing or walking or more with prolonged sitting as well. Also is it along the posterior buttock, posterior thigh and posterior calf? If not which area or the buttock, thigh and calf is involved. Did you have an MRI of the lumbar spine. If so what did it show? Thanks




Jessy:
I am 44yrs old lady .Before 12yrs I am having Disc Protrusion. I didn't take any medicines. Now I am severe back pain &leg pain also during menstruation period. So please kindly send any message in my Email to take any precautions.

Dr. Patel:
Does your back and leg pain only occur during menstruation? If not and your specialist feel it is correlated to the disc protrusion then I would avoid sitting for prolonged period of times for this can increase the pressure within the disc and increase back and leg pain. I would stand and walk for exercise if this does increase the painful symptoms. I would focus on stretching the hamstrings gently while laying on your back. Which areas of the buttock, thigh, and calf are typically affected? The posterior, lateral, or anterior parts?




Brenda:
I'm young, 57 years old. I've had both knees replaced at 50 & 51. I've been diagnosed with severe osteoarthritis in the majority of my joints, sacroiliac, have had surgery on both thumbs even. No, I can't handle any more surgeries. I've been on Opana ER, it worked perfectly, I felt 20 years younger. The new Opans ER does nothing except give me a headache and makes me extremely tired. I can't be on the move, walking, swimming. what medication is a replica of the old Opana ER 60 mg, taking twice a day. Something that doesn't sit on a empty stomach?

Dr. Patel:
I know they changed the way Opana ER is formulated now because there was abuse potential of the medication similar to oxycontin. It should work the same if not crushed. If it is not then you may want to convert the long acting to something different. Unfortunately there is no way to predict whether the opioid medication will cause side effects for yourself. Hope this helps.




Ken:
Which comes first: herniated disk or degenerative disc disorder (DDD)?

Dr. Patel:
Typically the degenerative changes to the disc occurs first increasing tension on the annulus fibrosis which essentially is protective outer layer to the disc. Once the annulus is disrupted then the nucleus pulpous can penetrate through the inner and outer annulus and create biochemical or biomechanical pain to the nerve roots inducting leg pain typically worse with prolonged sitting or lifting if the herniation is posterolateral in nature. Hope this helps.




Christy:
I am 26yrs old. I've had lower back pain since 1999, but the pain was never bad enough to get it checked. I didn't think I had a back problem, I thought the pain was coming from cross country running/marching band for 8yrs... anyway, its about a yr and a half of constant, pain. I've gone to a spine specialist. Physical therapy did help me, but only for a short time after the appointment. I've had two sets of injections done. The first gave a slight relief, the second, none. I had a xray and mri and they both came back not showing anything abnormal. Now, my doctor scheduled me for another injection.. they are very expensive because the health insurance my work offers is awful. My question is, what else could be wrong with me? I don't see my doctor in person for a month. He has been saying he thinks something is going on with my right si joint, but all my tests are negative and pt and injections don't help either. My pain is from the middle of my butt to 3 - 4 inches above my tailbone. I haven't slept well in a long time. It hurts when I stand, sit, lay, anything..

Dr. Patel:
It could be the right sacroiliac joint. Currently the diagnostic protocol for the diagnosing sacroiliac joint pain is to perform a diagnostic sacroiliac injection under xray guidance on 2 separate occasions. To evaluate whether the needle is in the joint you need contrast for confirmation. Then the only solution that should be injected to validate that it is diagnostic is a injecting an anesthetic like lidocaine or Marcaine only... Not steroid! If steroid is injected it is not diagnostic but a therapeutic injection into the sacroiliac joint. However if you typical pain is reduced down to 0-1 from your typical level on both occasions I would recommend 1-2 steroid injections into the sacroiliac joint with manipulation and pelvic stabilization program. However if you fail these simple conservative measures I would definitely recommend the IFUSE procedure from SI-BONE as a surgical next step. Hope this helps





MARCH 2012

Richard:
I have had discomforts in the area of my chest wall for years. It has recently been more prominent. I do have a hiatal hernia, and gerd; but I wanted to know if both sides of chest wall have discomforts could it be from the hiatal hernia? Thanks

Dr. Patel:
I am sure pain a hiatal hernia can create pain along both sides of the lower chest wall if severe enough. However other conditions can mimic this finding are costochondritis which is inflammation of the rib joint. Also cervical radiculopathy can cause pain over the chest wall from the C6 or C7 area. So if your chest wall pain increases with neck movement then let your physician know. Hope this helps.




Bob:
Post x-stop surgical changes at L5-S1 with severe facet arthorsis and hypertrophy of the ligamentum flava. No significant central canal stenosis but there is severe bilateral neural foraminal stenosis. Multi-level disc disease. Can the x-stop clamp be removed and alternate treatment be acomplished?

Dr. Patel:
Yes. The XSTOP is not typically performed at L5-S1. XSTOP is not indicated to be performed at L5-S1. However it can be removed. The important question is when you stand and walk do you have severe pain along the posterior buttock lateral thigh and lateral calf. If yes and the symptoms from the buttock down is more intense than the low back pain then I feel the severe foraminal stenosis at L5-S1 is probably causing your pain creating a condition called L5 radicular pain syndrome secondary to severe foraminal stenosis at L5-S1. Remember just because the MRI shows severe changes does not always mean it is causing your pain. MRI’s do not detect pain, patients do and it’s the physicians role to connect the dots between the pathology and your current symptoms. Hope this helps.




Chris:
In regards to the iFuse procedure, will this procedure prohibit any running & working out. I am very active and when researching the procedure it looks as if it may hinder the motion of an individuals gait when running? I had lower back surgery 4.5 yrs ago at Laser Spine Institute and it seems to have helped somewhat but not totally. I had a herniated disc. They cleaned up the jelly substance exiting the disc then shrunk the disc to give it more space. Episodes are not as often, 1-2 a year consisting of me on my back for 2-3 days on muscle relaxers & steroids. I came across the SI joint information and wondered if I may be a candidate? Please advise, looking for a miracle.

If the Laser Institute used laser technology to remove your disc herniation at L5-S1 for severe leg pain along the posterior buttock thigh and calf, and now you are noticing more pain at your belt line or below and it worsens more with sitting than standing and walking, then I feel the disc at L5-S1 is more likely to be the source of the pain. However if the low back is more worse when you’re standing and walking than sitting then the pain could be emanating from the zygapophyseal joint at L5-S1 secondary to the disc lacking height creating increase stress across the zygapophyseal, creating a painful syndrome called facetogenic pain syndrome. If your pain along your low back is worse while sitting, standing, or walking it is possible that the sacroiliac joint could be the source of the pain.

Dr. Patel:
Currently the diagnostic protocol for the diagnosing sacroiliac joint pain is to perform a diagnostic sacroiliac injection under xray guidance on 2 separate occasions. To evaluate whether the needle is in the joint you need contrast for confirmation. Then the only solution that should be injected to validate that it is diagnostic is a injecting an anesthetic like lidocaine or Marcaine only, not steroid! If steroid is injected it is not diagnostic but a therapeutic injection into the sacroiliac joint. However if you typical pain is reduced down to 0-1 from your typical level on both occasions I would recommend 1-2 steroid injections into the sacroiliac joint with manipulation and pelvic stabilization program. However if you fail these simple conservative measures I would definitely recommend the IFuse procedure from SI-BONE as a surgical next step. Hope this helps.




Laura:
I have done injections twice and been through PT. Both relieved the SI pain temporarily, but the pain always returns. I have been told that I am not a candidate for radiofrequency ablation or fusion. What would disqualify a patient from being a candidate for either of these procedures?

Dr. Patel:
I would have to know more information in your case. Were the injections diagnostic meaning the solution injected into the sacroiliac joint was only an anesthetic or was it with cortisone also? As for spinal fusion for low back pain perhaps your surgeon was hesitant as he believes there are not enough high level peer reviewed studies to support its effectiveness. In patients with severe leg pain because of nerve root cause when conservative treatment and interventional spine injections fail then surgery normally a good option.

Currently the diagnostic protocol for the diagnosing sacroiliac joint pain is to perform a diagnostic sacroiliac injection under xray guidance on 2 separate occasions. To evaluate whether the needle is in the joint you need contrast for confirmation. Then the only solution that should be injected to validate that it is diagnostic is a injecting an anesthetic like lidocaine or Marcaine only, not steroid! If steroid is injected it is not diagnostic but a therapeutic injection into the sacroiliac joint. However if you typical pain is reduced down to 0-1 from your typical level on both occasions I would recommend 1-2 steroid injections into the sacroiliac joint with manipulation and pelvic stabilization program. However if you fail these simple conservative measures I would definitely recommend the IFuse procedure from SI-BONE as a surgical next step. Hope this helps




Nat:
Hi, my Mum recently had L3, L4, L5 fused. Surgery was extremely successful and she is now home, but is not doing her breathing exercises, or any of the other exercises and is not going out walking at all, which has been instructed by the physiotherapists & surgeon. What does this mean for the prognosis of her back wellness & outcome of the surgery generally? Thanks.

Dr. Patel:
She should at least be moving around and standing and walking at her own pace. She does not need to perform rigorous exercises but simply standing and walking or getting up from a chair rather than just sitting most of the time should be emphasized. She should be performing her breathing exercises to increase her vital capacity to help increase her ability to stand and walk for longer periods of time without exertion fatigue. Hope this helps.




Maria:
I have just been advised that I don’t have a disc on C7 T1 in my neck. Not sure how serious this might be and what it would involve as far as treatment is concerned. I had chest pains and tingly arm and apparently it is due to this? Can you advise me please.

Dr. Patel:
If you have severe disc space collapse at C7-T1 then you could be at risk of developing a condition called C8 radicular pain syndrome secondary to a condition called foraminal stenosis which could be moderate to severe. When the disc space collapses, the neural foreman will decrease in size along the superior to inferior dimension potential creating stress along the C8 nerve root especially if your looking up or to each side. A CT of the cervical spine or MRI of the cervical spine will show this finding. However disc or the facet joint at this level could be other potential reasons for developing chest pain and tingling in the arm. If the pain gets worse there are diagnostic protocols from an interventional standpoint that could help delineate between facet joint vs nerve root vs disc mediate pain that could be corroborative with your chest pain and associated tingling. Hope this helps.




Nyron:
Hi Dr i have a spine problem and sometime i don`t feel like i do have it i can do all most everything i don’t think i have a badly problem but what i would like to know if it is a possibility that i can have children? Hi Doctor. I have a spine problem, but sometimes I feel it and sometimes I don’t. It doesn’t seem to be a bad problem but I would like to know how this impacts child bearing. I also would like to have a surgery; I just need some more information.

Dr. Patel:
Yes you can have children. However it is difficult to predict whether you will have more pain during your pregnancy or after your pregnancy. I would get a wellness exam and have a specialist evaluate your back. Surgery is indicated for many reasons. However your pain appears to be manageable. Also we still need to delineate where your pain is emanating from. Hope this helps.




Chris:
Hello, I have been living with lower back and hip pain now for over 10 years. I have had 2 MRI's, they show nothing wrong with my back as far as disk issues. I have had 2 series of back injections and that has not worked. I have been to a rheumatologist and he could not figure it out. This is why I believe it's my sacroiliac joint. I am trying to find a doctor that is tailored with this issue. I have all the symptoms and never a proper diagnosis. What is my next course of action? Thank you

Dr. Patel:
Currently the diagnostic protocol for the diagnosing sacroiliac joint pain is to perform a diagnostic sacroiliac injection under xray guidance on 2 separate occasions. To evaluate whether the needle is in the joint you need contrast for confirmation. Then the only solution that should be injected to validate that it is diagnostic is a injecting an anesthetic like lidocaine or Marcaine only, not steroid! If steroid is injected it is not diagnostic but a therapeutic injection into the sacroiliac joint. However if you typical pain is reduced down to 0-1 from your typical level on both occasions I would recommend 1-2 steroid injections into the sacroiliac joint with manipulation and pelvic stabilization program. However if you fail these simple conservative measures I would definitely recommend the IFUSE procedure from SIBONE as a surgical next step. Hope this helps




Sue:
Hi Dr Patel. I've had many years of back pain issues. 2 discectomies in 2006, 2-level PLIF in 2010 and revision surgery last December 2011. I still have ongoing pain issues coming from my back/sciatica. In May last year, my surgeon tested me for SI joint pain and said it was positive. I had a steroid injection into SI joint for diagnostic purposes and sadly only got 24 hours pain relief. I am on the waiting list to have another injection, but here in the UK it can take many months to get an appointment on the NHS. I am happy to wait though, for any pain relief is totally worth it.

My surgeon does not perform SI joint fusions (which I'm grateful for, as I never want another spine operation again!), so I'm wondering what other treatments might be available for me if the injection isn't successful? Are you able to advise me further, and also, would you know of any surgeons here in the UK that specializes in this area as I may want a second opinion in the future.

I am unable to work at the moment and desperately need to find out more information as it's so painful to sit on a normal chair for more than 20 minutes (the pain is deep in my right buttock and lower right limb, into my foot).

Any information you can provide would be much appreciated. Thank you, Sue

Dr. Patel:
Currently the diagnostic protocol for the diagnosing sacroiliac joint pain is to perform a diagnostic sacroiliac injection under xray guidance on 2 separate occasions. To evaluate whether the needle is in the joint you need contrast for confirmation. Then the only solution that should be injected to validate that it is diagnostic is a injecting an anesthetic like lidocaine or Marcaine only, not steroid! If steroid is injected it is not diagnostic but a therapeutic injection into the sacroiliac joint. However if you typical pain is reduced down to 0-1 from your typical level on both occasions I would recommend 1-2 steroid injections into the sacroiliac joint with manipulation and pelvic stabilization program. However if you fail these simple conservative measures I would definitely recommend the IFuse procedure from SI-BONE as a surgical next step.

However if the diagnostic sacroiliac injection is negative for at least an 80 percent reduction of your typical right leg pain with normal activities then I would recommend a repeat MRI of the lumbar with and without contrast to evaluate for perineural fibrosis around the L5 or S1 nerve roots that could be the source of your pain. If this is seen I would recommend a diagnostic selective nerve root injection. If positive for at least an 80 percent reduction of your right leg pain with normal activities, then I would recommend a spinal cord stimulator trial. If positive for an at least an 80 percent reduction of your leg pain with normal activities then I would recommend implantation of the device. Hope this helps.




David:
After 4 weeks of back pain, I now have Severe pain back of my knee and right ankle and only when I am standing. My back pain is almost gone. What do I do? The pain is Severe, Excruciating and unbearable.

Dr. Patel:
What did your MRI of the lumbar spine show? Disc herniation to the right at L5-S1? A central disc herniation at L4-5? Moderate to severe central stenosis at L4-5? A synovial cyst to the right at L4-5? Is this pain more severe when you walk o when you sit? Hope this helps.




Linda:
Should iFuse be offset with pedicle screws on the other non-painful side? Would fusion shift the joint so it's no longer level with the screw on opposing the implant?

Dr. Patel:
No. Treat the symptoms only. If it turn out that the other sides is giving you problems and not manageable then also get it addressed. Hope this helps.




Fatama:
I am a 30 years lady. I have a 2.6 year old baby. Both my SI joint bblique view impression is bilateral sacroiliitis. What is this? And what type treatment has?

Dr. Patel:
The first question is do you have pain? If yes people with sacroiliac joint pain (SIJ) will have pain at their belt line or below and it worsens with sitting and standing/walking as they want to lean away from the painful side. Remember imaging studies to do not detect pain. So patients can have similar findings and have no symptoms whatsoever.

Currently the diagnostic protocol for the diagnosing sacroiliac joint pain is to perform a diagnostic sacroiliac injection under xray guidance on 2 separate occasions. To evaluate whether the needle is in the joint you need contrast for confirmation. Then the only solution that should be injected to validate that it is diagnostic is a injecting an anesthetic like lidocaine or Marcaine only, not steroid! If steroid is injected it is not diagnostic but a therapeutic injection into the sacroiliac joint. However if you typical pain is reduced down to 0-1 from your typical level on both occasions I would recommend 1-2 steroid injections into the sacroiliac joint with manipulation and pelvic stabilization program. However if you fail these simple conservative measures I would definitely recommend the IFuse procedure from SI-BONE as a surgical next step. Hope this helps




David:
I have constant chronic debilitating pain in my lower back and especially around my hip area, back and front. Especially around the front radiating (it seems) from around the hip joint itself. Also when I sit in any position my tailbone hurts like Hell. I have had several MRI's of my spine, but never the pelvic/tailbone area. There is considerable wear and tear, and arthritic damage in the upper spine, but no absolute herniation noted. A few years ago I fell of a bicycle and fractured my leg just below the hip joint. As a result I now have an artificial hip on my left side. I have very notable scoliosis (from birth) that only bothered me starting about 5 years ago (I am 60) when my spine bent further, taking my hips out of alignment with my shoulders, one hip higher than the other, and one leg shorter than the other. Movement is totally asymmetrical and tortured. All this made worse by hereditary peripheral neuropathy, making both feet feel as though they are in boiling water. I was on methadone for all this, but I am blessed (cursed) with huge tolerance for opiates and could no longer sustain the massive dosage and the side effects. I am through a very miserable withdrawal and am now free from opiates. The result, however, is worse pain constantly. I take Lyrica for the neuropathy and it helps.

Dr. Patel:
If you are having chronic low back pain along the waist line radiating into the hip area and the level of the pain is the greatest when your standing or walking greater than sitting the pain could be referred for the facet joint at L5-S1. However, if the pain is more painful with sitting and standing and walking the pain could be referred from the sacroiliac joint as well. Its seems the inciting event was the fall that fractured the hip on the left side. The diagnostic protocol towards diagnosing the sacroiliac joint is to perform a diagnostic sacroiliac joint under x-ray guidance utilizing contrast to confirm needle placement and injecting no more than 1.7 ml of anesthetic and to also make sure the medication is not leaking out of the sacroiliac joint. If you obtain at least a 75 percent reduction of your typical pain with functional activities, I would recommend having it done again for consistency of results. If positive again then I would consider a cortisone injection into the sacroiliac joint 1-2 times in conjunction with a pelvic stabilization program and stretching of the hamstring muscles and possible manual medicine under the care of the physical therapist, osteopathic physician, or chiropractor. However if you fail to get good to excellent functional relief for at least 16 weeks then I would consider a minimally invasive sacroiliac joint fusion. However if the diagnostic sacroiliac injection is negative I would consider a diagnostic lumbar medial branch block at L5-S1 to see if this reduces your typical back and hip pain by at least 75 percent. If positive I would consider getting it repeated for consistency of results and if positive then consider radiofrequency ablation of the medial branches at L5-S1. Remember that a diagnostic injection is only when an anesthetic is injected only not with cortisone. Also with the diagnostic lumbar medial branch block no more than 0.5 ml of anesthetic should be injected at each level to maintain specificity of the injection. Hope this helps!




JoAnn:
What kind of pain relief can I expect from having this new kind of surgery. I have tried everything and anything to help with this problem that I have had for 20 some years.

Dr. Patel:
It depends. If you had the appropriate diagnostic protocol toward diagnosis of the sacroiliac joint pain syndrome then I would suggest more than likely you will have a successful outcome. There are no percentages at this point but my personal feeling based on the retrospective data is that this minimally invasive sacroiliac joint fusion will be the reference standard for intra-articular sacroiliac joint pain when steroid injections, manual medicine, and pelvic stabilization with sacroiliac joint belt does not work.

The diagnostic protocol towards diagnosing the sacroiliac joint is to perform a diagnostic sacroiliac joint under x-ray guidance utilizing contrast to confirm needle placement and injecting no more than 1.7 ml of anesthetic and to also make sure the medication is not leaking out of the sacroiliac joint. If you obtain at least a 75 percent reduction of your typically pain with functional activities I would recommend having it done again for consistency of results. If positive again then I would consider a cortisone injection into the sacroiliac joint 1-2 times in conjunction with a pelvic stabilization program and stretching of the hamstring muscles and possible manual medicine under the care of the physical therapist, osteopathic physician, or chiropractor.




Judy:
I had Facet injections and after that I had Radiofrequency injections. Since then my sciatic nerve is running up and down my leg and it is so painful about a 10 in pain. I told the Doctor but now he wants to give me a codal injection. I have double knee replacements and when I had the radiofrequency done it felt like my knee and leg was burning inside very hot.? Can you advise me. Thank You.

Dr. Patel:
Did you have the pain down your legs before the RFA? Does your pain radiate along posterior buttock, thigh and calf or lateral thigh and calf or anterior thigh or calf? Next does your pain down the legs increase the fastest with standing and walking or with sitting or all three equally? However if the pain down the legs had occurred since the RFA then I would recommend a medrol dose pack first and if that doesn’t work consider Neurontin three times a day. Also could you tell me which medial branches were heated with the RFA machine? Thanks




Ruth:
I had a two level (L4-S1) lumbar fusion with instrumentation in June 2008. It was my 3rd lumbar surgery, but my first fusion. When I sweep or vacuum around the house I am rendered pretty much functionally disabled by severe crippling pain within 2-3 minutes of starting the activity. The pain I get is bilateral, approximately 2-3 inches from the midline incision, with this pain running from belt line to about 4 inches from the bottom of the buttocks. When I get this pain it feels as if someone is trying to pull the nerves/muscles there out of my low back with a fork. It is sickeningly nauseating. Could this be an SI joint issue? It feels as if I were to continue sweeping that I might rip a muscle or tendon there. I've never had this pain before so it is disturbing. Do you think it is worth it to ask my family physician for imaging, and/or do you think it is treatable?

Dr. Patel:
This is a very good question. Based on recent data patients with lumbar spine fusion extending into L5-S1 can have sacroiliac joint pain approximately 43 percent of the time in patients with low back after surgery. The time frame towards developing sacroiliac joint pain can truly vary from weeks to years.

The diagnostic protocol towards diagnosing the sacroiliac joint is to perform a diagnostic sacroiliac joint under xray guidance utilizing contrast to confirm needle placement and injecting no more than 1.7 ml of anesthetic and to also make sure the medication is not leaking out of the sacroiliac joint. If you obtain at least a 75 percent reduction of your typically pain with functional activities I would recommend having it done again for consistency of results. If positive again then I would consider a cortisone injection into the sacroiliac joint 1-2 times in conjunction with a pelvic stabilization program and stretching of the hamstring muscles and possible manual medicine under the care of the physical therapist, osteopathic physician, or chiropractor.

Hope this helps!




Todd:
I have been receiving bi lateral SI rf injections for years with great success lasting 6-12 months per injection. My insurance company is no longer covering the injections and my doctor will no longer perform the procedure because of this. I do not know what else to do as I have no options left and my pain is debilitating. Any suggestions or help would be greatly appreciated.

Dr. Patel:
It seems the growing consensus is RFA of the sacroiliac joint is more effective for extrarticular causes of sacroiliac joint pain rather than intra-articular sacroiliac joint pain. This is what I would do first if it has not been done.

The diagnostic protocol towards diagnosing the sacroiliac joint is to perform a diagnostic sacroiliac joint under x-ray guidance utilizing contrast to confirm needle placement and injecting no more than 1.7 ml of anesthetic and to also make sure the medication is not leaking out of the sacroiliac joint. If you obtain at least a 75 percent reduction of your typically pain with functional activities I would recommend having it done again for consistency of results. If positive again then I would consider minimally invasive sacroiliac joint fusion.

Hope this helps!




Karen:
I have just been told that L5 in my back is the cause of the constant pain in my legs and in my back. Also now that l2 and l4 are damaged as well can you tell me if there is anything that can be done to rectify the problems.

Dr. Patel:
The first question is the pain along the lower back more powerful in pain intensity compared to the pain from the buttock down the legs? Or vice versa? Next how does the pain from the buttock down the leg travel? Does it travel down the back of the thigh and calf, the side of the thigh and calf or the front of the thigh and calf? Next which movement increases the back and leg pain the fastest? Is it sitting or standing or walking or going from sit to stand?

Also could type in what the report said about L3-4, L4-5 and L5-S1?




Todd:
I saw a spine doctor once and said I had mild sacroiliitis on the left. I've had a vibration in my foot for over a year and wondered if that would also be a symptom for a patient with sacroiliitis.

It could be or nerve root problem affecting the left L5 or Left S1 nerve root.

Dr. Patel:
The first question is the pain along the lower back more powerful in pain intensity compared to the pain from the buttock down the legs? Or vice versa? Next how does the pain from the buttock down the leg travel? Does it travel down the back of the thigh and calf, the side of the thigh and calf or the front of the thigh and calf? Next which movement increases the back and leg pain the fastest? Is it sitting or standing or walking or going from sit to stand?

Have you had an MRI of the lumbar spine? If so what did L4-5 and L5-S1 show in the report?

The diagnostic protocol towards diagnosing the sacroiliac joint is to perform a diagnostic sacroiliac joint under x-ray guidance utilizing contrast to confirm needle placement and injecting no more than 1.7 ml of anesthetic and to also make sure the medication is not leaking out of the sacroiliac joint. If you obtain at least a 75 percent reduction of your typically pain with functional activities I would recommend having it done again for consistency of results. If positive again then I would consider a cortisone injection into the sacroiliac joint 1-2 times in conjunction with a pelvic stabilization program and stretching of the hamstring muscles and possible manual medicine under the care of the physical therapist, osteopathic physician, or chiropractor.

Thanks





FEBRUARY 2012

Lisa:
I hurt my back in June 2010 and have since had a pinching sensation in my right side of my buttock and a shooting pain down my right leg. My pain management tells me it just muscle spasms or arthritis. She also mentioned something about my S1 and L5 but now insists its just muscle spasms. She refuses to refer me to an actual spinal doctor and nerve conduction studies. I don't know how to get her to understand the pain I'm in and help me figure out what is really wrong with me. Do you have any suggestions on what I can do? She also did an epidural steroid block shot on me today.

Dr. Patel:
You should consider getting a second opinion. Keep a diary of your pain symptoms and what makes the pain better or worse. Typically when you complain of right posterior buttock pain along with radiating symptoms along the posterior thigh and posterior calf the diagnosis is typically a herniated disc to the right at L5-S1 irritating the right S1 nerve root or a sacroiliac joint problem. However if your are having more posterolateral buttock pain that radiates into the lateral thigh and lateral calf then this would more an L5 nerve root pain or sacroiliac joint as well. Typically a herniated disc increases nerve root pain with sitting and leaning forward and feels better with standing and walking. However sacroiliac joint pain hurts with sitting standing or walking. Before ever considering an epidural or nerve root injection or sacroiliac joint injection you should have had an MRI of the lumbar spine without contrast to evaluate whether there are findings that could correlate with your symptoms. If you are having weakness along the leg then an EMG Nerve conduction study is useful to evaluate the quality of the nerve root damage. In some cases if the qualitative damage to the nerve is severe with this study then surgery may need to be the next option. I hope this helps. Take care.




Craig:
I might be having a three level fusion L3-L4, L4-L5,and L5-S1. If I get this done will I have problems in the future at the sacroiliac joint. Just wondering if I need to know and what problems to look for. Thank you Craig

Dr. Patel:
This is an excellent question. Approximately 15 to 30 percent of the US population suffers from sacroiliac joint pain but it is 43 percent in patients fused down to L5-S1. The time from surgery to developing the symptoms is unknown and varies from immediately post surgery to 5-10 years based on personal experiences with patients. Typically you will have pain along the posterior buttock region in the region of the dimple between the low back and buttock region. This is called the posterior superior iliac spine. When your primary pain is this low over this site and slightly medial to this site the predictive value that it is from the sacroiliac joint is approximately 60 percent. Then you should see an interventional pain management specialist for further evaluation. Typically they will recommend an anesthetic injected into the SIJ (sacroiliac joint) using contrast


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